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Research Article Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints Akash Tariq, 1 Sakina Mussarat, 1 Muhammad Adnan, 1 E. F. Abd_Allah, 2 Abeer Hashem, 3,4 Abdulaziz Abdullah Alqarawi, 2 and Riaz Ullah 5 1 Department of Botany, Kohat University of Science and Technology, Kohat 26000, Pakistan 2 Plant Production Department, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia 3 Botany and Microbiology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia 4 Mycology and Plant Disease Survey Department, Plant Pathology Research Institute, Agriculture Research Center, Giza 2109, Egypt 5 Department of Chemistry, Government College Ara Khel, Frontier Region Kohat 26000, Pakistan Correspondence should be addressed to Akash Tariq; [email protected] Received 31 December 2014; Revised 14 March 2015; Accepted 27 April 2015 Academic Editor: Gail B. Mahady Copyright © 2015 Akash Tariq et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim of the present study was to document ethnomedicinal plants used against gastrointestinal complaints in five selected remote regions of Pakistan and to select potential medicinal plants for further in vitro and in vivo investigation. Data on ethnomedicinal plants and ethnographic profile of respondents was documented using semistructured questionnaires. e present study revealed utilization of 52 medicinal plants for the treatment of different gastrointestinal infections in studied regions. Apiaceae was the most dominant family reported to be used for the treatment of these infections (4 plants). Among all the plant parts fruit (24%), whole plants and leaves (23% each) were the most preferred plant parts used by the healers. Dosage of recipe was found to be related with the age of the patient. Highest degree of informant consensus was reported for vomiting, nausea (0.92 each), abdominal pain (0.9), and diarrhea (0.89). Withania coagulans scored highest FL value (86%) followed by Mentha longifolia and Melia azadirachta ranked second with FL value (75% each). Young generation was found to possess little traditional knowledge about utilizing plant recipes against these infections. Plants with high Fic and FL values should be subjected for further phytochemical and pharmacological investigation for scientific validation. 1. Introduction Plants are an important resource of conventional medicines used against different ailments. Rural people who have cen- tury’s old traditional knowledge transferred from generation to generation still rely on plant resources for variety of purposes such as food, fodder, and medicines. Rural area people heavily depend on natural resources due to lack of modern medical facilities [1]. More than 80% of population in Pakistan is dependent on traditional medicines for health practices [2], but now it is restricted to rural areas [3], due to divergence of people toward modern health facilities in urban areas and also due to changing life styles with the passage of time. is centuries old traditional knowledge is facing severe threat due to modernization in rural societies. Total 6000 plant species have been documented in Pakistan among which only 600 plants have been reported in ethnomedicinal studies [4]. It is therefore imperative to increase ethnomedic- inal studies in order to preserve this precious knowledge before its extinction [5]. Gastrointestinal disorders are common in Southwest of Khyber Pakhtunkhwa because these areas lack hygienic condition and malnutrition as well as having insufficient availability of pure water. Approximately 103 million people in Pakistan with an annual growth rate of 3% [6] and population density is recorded 151.8 per square kilometer [7]. Major health risks in Pakistan are extensive commu- nicable diseases, insufficient sewage systems, and lack of pure drinking water [8, 9]. e high infant morbidity and mortality rates reflect inadequate nutrition and exposure to polluted water [6]. Most of the infectious diseases are caused by microorganism such as Vibrio cholerae, Escherichia coli, Hindawi Publishing Corporation BioMed Research International Volume 2015, Article ID 892947, 14 pages http://dx.doi.org/10.1155/2015/892947

Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

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Page 1: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

Research ArticleEthnomedicinal Evaluation of Medicinal Plants Used againstGastrointestinal Complaints

Akash Tariq1 Sakina Mussarat1 Muhammad Adnan1 E F Abd_Allah2 Abeer Hashem34

Abdulaziz Abdullah Alqarawi2 and Riaz Ullah5

1Department of Botany Kohat University of Science and Technology Kohat 26000 Pakistan2Plant Production Department College of Food and Agricultural Sciences King Saud University Riyadh 11451 Saudi Arabia3Botany and Microbiology Department College of Science King Saud University Riyadh 11451 Saudi Arabia4Mycology and Plant Disease Survey Department Plant Pathology Research Institute Agriculture Research Center Giza 2109 Egypt5Department of Chemistry Government College Ara Khel Frontier Region Kohat 26000 Pakistan

Correspondence should be addressed to Akash Tariq akashmalik786yahoocom

Received 31 December 2014 Revised 14 March 2015 Accepted 27 April 2015

Academic Editor Gail B Mahady

Copyright copy 2015 Akash Tariq et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Aim of the present study was to document ethnomedicinal plants used against gastrointestinal complaints in five selected remoteregions of Pakistan and to select potential medicinal plants for further in vitro and in vivo investigation Data on ethnomedicinalplants and ethnographic profile of respondents was documented using semistructured questionnaires The present study revealedutilization of 52 medicinal plants for the treatment of different gastrointestinal infections in studied regions Apiaceae was the mostdominant family reported to be used for the treatment of these infections (4 plants) Among all the plant parts fruit (24) wholeplants and leaves (23 each) were the most preferred plant parts used by the healers Dosage of recipe was found to be related withthe age of the patient Highest degree of informant consensus was reported for vomiting nausea (092 each) abdominal pain (09)and diarrhea (089)Withania coagulans scored highest FL value (86) followed byMentha longifolia andMelia azadirachta rankedsecond with FL value (75 each) Young generation was found to possess little traditional knowledge about utilizing plant recipesagainst these infections Plants with high Fic and FL values should be subjected for further phytochemical and pharmacologicalinvestigation for scientific validation

1 Introduction

Plants are an important resource of conventional medicinesused against different ailments Rural people who have cen-turyrsquos old traditional knowledge transferred from generationto generation still rely on plant resources for variety ofpurposes such as food fodder and medicines Rural areapeople heavily depend on natural resources due to lack ofmodern medical facilities [1] More than 80 of populationin Pakistan is dependent on traditional medicines for healthpractices [2] but now it is restricted to rural areas [3] due todivergence of people towardmodern health facilities in urbanareas and also due to changing life styles with the passageof time This centuries old traditional knowledge is facingsevere threat due to modernization in rural societies Total6000 plant species have been documented in Pakistan among

which only 600 plants have been reported in ethnomedicinalstudies [4] It is therefore imperative to increase ethnomedic-inal studies in order to preserve this precious knowledgebefore its extinction [5]

Gastrointestinal disorders are common in Southwestof Khyber Pakhtunkhwa because these areas lack hygieniccondition and malnutrition as well as having insufficientavailability of pure water Approximately 103 million peoplein Pakistan with an annual growth rate of 3 [6] andpopulation density is recorded 1518 per square kilometer[7] Major health risks in Pakistan are extensive commu-nicable diseases insufficient sewage systems and lack ofpure drinking water [8 9] The high infant morbidity andmortality rates reflect inadequate nutrition and exposure topolluted water [6] Most of the infectious diseases are causedby microorganism such as Vibrio cholerae Escherichia coli

Hindawi Publishing CorporationBioMed Research InternationalVolume 2015 Article ID 892947 14 pageshttpdxdoiorg1011552015892947

2 BioMed Research International

Shigella spp Salmonella spp Aeromonas spp Pseudomonasspp Campylobacter spp Klebsiella spp and Staphylococcusaureus [10] However antibiotic resistance is a major clinicalproblem in treating infections caused by these microor-ganisms Synthetic drugs such as proton pump inhibitorsH2 receptors cytoprotectants demulcents anticholinergicsantacids and prostaglandin analogues are used for the treat-ment of gastro problems but these drugs produce several sideeffects Herbal remedies are considered as better alternativesfor the treatment For example proton pump inhibitors(omeprazole lansoprazole) may cause nausea abdominalpain constipation and diarrhea and H2 receptor antagonists(cimetidine)may cause gynaecomastia and loss of libido Dueto the occurrence of many side effects by use of syntheticdrugs for many diseases medicinal plants are considered asthe main source of new drugs as they have less or no sideeffects Herbal medicines are considered as safe with lesseradverse effects economical effective relatively less toxic andextensive research is carried out in search for potent drugs ofplant origin [11] In Pakistan and other countries a variety ofmedicinal plants are used against gastrointestinal complaintssuch as diarrhea dysentery and cholera However manyof them have not been screened for their phytochemistryand pharmacological action against microbes which couldsupport their use in traditional medicines

The present study was the first effort to target gastroin-testinal infections and their traditional recipes in five remotesouthern regions of Khyber Pakhtunkhwa province of Pak-istan where these infections were found more common Themain purpose of the study was to conserve the ethnomedic-inal knowledge and to select candidate medicinal plants forfurther phytochemical and pharmacological investigationThe available literature shows that such studies can constitutethe starting point for the development of new drugs [12 13]Our efforts are towards not only providing nutrition andhealth care to the people but also recovering record anddiffuse local botanical knowledge and traditional wisdom

2 Material and Methods21 Study Area The present study was conducted in fivemajor remote areas (Dera Ismail Khan Bannu LakkiMarwatand Karak and Kohat) of Khyber Pakhtunkhwa province ofPakistan (Figure 1) D I Khan is an area of 7326 squarekilometers and is situated between 31∘151015840 and 32∘321015840N latitudeand between 70∘111015840 and 71∘201015840E longitude Most of the areaof D I Khan is flat dry alluvial plains supporting mostlyxerophytic vegetation Dominant plant species are Acaciamodesta Acacia nilotica Calotropis procera Morus albaand Eucalyptus camaldulensis Most of the population ofthe area is rural with low literacy rate and they also lackmodern health facilities hence they are more dependentupon natural resources especially plants for their healthcareand to compensate their low income as well [14] Bannuconsists of a total area of 877 square kilometers with apopulation of 19593 It lies within the Karakoram mountainrange between 32∘43 to 33∘06N latitude and 73∘20 to 70∘07Elongitude The total cultivated area is about 33000 acreswith wheat maize and sugarcane being the main cultivated

crops About 25 of the inhabitants of the area as well asAfghan refugees are engaged in the collection and marketingof medicinal plantsThe area consists of alluvial plain with anannual rainfall of 11136mm The dominant plant species areAcaciamodestaAcacia niloticaCalotropis proceraDodonaeaviscosa andWithania somnifera [15] Karak region is situatedin the south of KPK with total area of 600 square kilometersand lies between 70-40∘ to 71-30∘N latitude and 32-48∘ to 33-23∘E longitude The study area is divided into mountainousarea small hills and plains having most of clayey or sandysoil Wheat corn and gram are the common cultivatedcrops Various plant species dominated the study area suchas Acacia modesta Acacia nilotica Adhatoda vasica Aervajavanica Dodonaea viscosa Eucalyptus lanceolatus Fagoniacretica Rhazya stricta Saccharum arundinaceum Withaniacoagulans and Withania somnifera [16] Kohat is located at33∘35101584013N 71∘26101584029E with an altitude of 489m above sealevel The dominant vegetation of the study area is Zizyphusspecies Acacia species and other xerophytes plants The areais rural in nature and inhabitants are very much dependenton plants for agricultural economic and food purposesLocals of the region use a variety of medicinal plants for thetreatment of various ailments due to expensivemodern drugs[17] Lakki Marwat is situated between 32∘161N latitude and70∘191E longitude at altitude of 200ndash1000m above sea levelThis district covers an area of 3164 km2 with a cultivated areaof approximately 116900 ha The indigenous people of thedistrict are Marwat tribes but a small proportion of othertribes also settled here Transport and minerals are the mainsources of economy in the urban area and agriculture is theprimary livelihood of the rural population The major ethnicgroup in this district speaks Pashto (993) which is spokenin a specific dialect [18] The remaining population speaksPunjabi (07) in Hindko dialect

22 Sampling and Data Collection Data collection was car-ried out from 2013 to 2014 Prior to data collection localadministrative officers of the regions were visited and it wasexplained them themain idea of the study in order to get theirpermission According to the information provided by thelocal administrative officers 350 respondents were selectedin five studied region with 70 informants in each regionThe selection criterion of informants was mainly based ontheir rich indigenous knowledge and long term experienceof utilization of plants as well as their living period of timein the study area Selected respondents of the regions wereaged between 30 and 79 years Verbal consent includingconsent for publication was received from all the informantsbefore the interviews began The informants are aware thatthe information they have provided will be published andthat data will be used only for scientific purposes Data wascollected in local language (Saraiki Hindko and Pashto) andconverted into English Semistructured questionnaires weredesigned to collect ethnomedicinal knowledge of medicinalplants used against gastrointestinal infections

23 Plants Collection and Identification Plants were collectedwith the help of respondents from wild and cultivated areasCollected voucher specimens were taken to the Herbarium

BioMed Research International 3

Afghanistan

Charikar

Jalalabad

Khyber Agency

Kabul

Gardeyz

Khowst

SharZarghun North

SouthWaziristan

Balochistan

WaziristanRazmak

Miranshah

Wana

Jandola

LakkiMarwat

Tank

Zhob

Dera IsmailKhan

Dera

KhanIsmail

Bannu

Karak

Hangu

KurramAgency

ParachinarLandi

MohmandAgency

Kotal

Orakzai Agency

KohatKohat

Mianwali

Kalabagh

Panjab

Pakistan

Islamabad

Murree

India

BajaurAgency

DirDir

Swat

Shangla

Mansehra

Chitral

Chitral

Mastuj

Mt Tirich MirMor Khun

Northern Areas

Gilgit

AgencyMalakand

Nowshera

Charsadda

Peshawar

MardanSwabi

Buner

HaripurAbbottabad

Tajikistan

Kalam DasuKohistan

SaiduSharif

Naran

MansehraBattagram

Figure 1

of Kohat University of Science and Technology (KUST)Kohat Pakistan Specimen identification and confirmationwere undertaken by using Flora of Pakistan and taxonomicexperts Specimens with their label were stored at theHerbar-ium of KUST Kohat Pakistan

24 Data Organization The collected data on ethno medic-inal plants and ethnography of the respondents was orga-nized using Microsoft Excel 2007 and summarized usinggraphical statistical methods such as percentages The habitof the plants was categorized into 3 classes (herbs shrubsand trees) Life form of medicinal plants was classified

into annual biennial and perennial Plant parts use wascategorized into leaves roots stem whole plant seedsfruit and flower Stomach disorders were divided into sixmajor categories that is diarrhea dysentery abdominal painintestinal worms constipation and nausea and vomiting

25 Data Quality Assurance Each respondent was ap-proached at least three times during data collection for 5 thelegitimacy of information they provided Information wasconsidered irrelevant and rejected in case of any divergencefrom the original information of the respondent Valid datawas only subjected to further analysis process Further data

4 BioMed Research International

quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis

26 Data Analysis

261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows

Fic = nur minus ntnur minus 1

(1)

where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used

262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula

FL = IpIutimes 100 (2)

where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]

3 Results

In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred

plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)

Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)

Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives

4 Discussion

41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]

42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs

BioMed Research International 5Ta

ble1Medicinaluses

ofplantsforstomachtro

ubles

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Abutilonindicum

(L)Sw

eet

Malvaceae

Koso

beta

SA

WWhpl

Decoctio

nor

powderisu

sed

againstcon

stipatio

n1tea

spoo

naft

ermeal

2ndash4teas

poon

saft

ermeal

Lakk

iMarwat

Acaciamodesta

Wall

Mim

osaceae

Phulahi

TP

WBa

Decoctio

nismadeb

ybo

iling

bark

inwater

orpo

wdero

fbark

ismadeb

ygrinding

theb

arkfor

treatmento

fgas

troub

leand

abdo

minaldiseases

2spoo

nsaft

er4h

rsfor1

day

3-4spoo

nsaft

er2h

rsfor2

days

ordepend

son

severity

DIK

han

Acacianilotica(L)Delile

Mim

osaceae

Kikar

TP

WPo

Ba

Decoctio

nof

theb

arkisused

indiarrhea

andpo

dsareg

rindedto

makep

owderm

ixed

with

sugar

orho

neyto

treatdysentery

Smallamou

ntof

powderisg

iven

for1-2

days

500m

ggiven

twicea

dayfor3

days

Kohat

Achyranthesa

speraL

Amaranthaceae

Gho

shkai

HP

WWhpl

Itsdecoctionisused

insto

mach

disorderTh

ejuice

ofthep

lant

isused

inabdo

minalpain

dysenteryandin

bowel

complaints

Depends

ondiseases

everity

Depends

ondiseases

everity

Bann

u

Albizialebbeck

(L)Be

nth

Mim

osaceae

Sirin

TP

CBa

Bark

decoctionisused

totre

atdiarrhea

1-2spoo

n3tim

esad

ay1-2

spoo

naft

er3h

rsfor1

day

Bann

u

Alliu

mcepa

LLiliaceae

Piaz

HA

CBu

Equalamou

ntso

fextractof

onionbu

lbandmintare

mixed

andgivenforc

holera

Halftea

spoo

nof

thismixture

istakenperh

our

fora

perio

das

needed

One

teas

poon

ofthismixture

istakenperh

our

fora

perio

das

needed

DIK

han

Argyrolobium

roseum

(Cam

bess)

Jaub

ampSpach

Nyctaginaceae

Muk

hanBu

tti

SB

WWhpl

Diarrhea

Bann

u

Artemisiaa

bsinthium

LAs

teraceae

Afsanteen

HB

WL

Leaves

areb

oiledto

expel

intestinalwormsindigestion

diarrheaand

vomiting

Asn

eeded

Asn

eeded

Kohat

Asparagusadscend

ensR

oxb

Asparagaceae

Safid

muesli

HA

WR

Groun

droot

iseffectiv

efor

carm

inative

Asn

eeded

Asn

eeded

Karak

Azadira

chta

indica

AJuss

Meliaceae

Neem

TP

CL

Decoctio

nof

leaves

istakenfor

digestivea

ndgastric

prob

lems

2teas

poon

sfor

oned

ay2teas

poon

sfor

oned

ay

DIK

han

Lakk

iMarwat

Bisto

rtaam

plexica

ulis(D

Don

)Greene

Polygonaceae

Masloon

Anjabar

HP

WWhpl

Con

stipatio

nBa

nnu

Kohat

Boerhaavia

diffu

saBrandegee

Nyctaginaceae

Punara

HP

WR

Gas

troub

les

Karak

Camelliasin

ensis

(green

tea)

LKu

ntze

Theaceae

Sabz

pati

HP

CL

Leaves

areb

oiledin

water

mixed

somes

ugar

andtake

orallyfor

indigestionandnausea

1orh

alfcup

once

aday

1cup

aday

DIK

han

Bann

uLakk

iMarwat

6 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Carissa

opacaStapfex

Haines

Apocyn

aceae

Grand

aS

AWC

LR

FDysentery

Karak

Carumcopticu

m(L)Be

nthamp

Hoo

kfex

CB

Clarke

Umbelliferae

Spaerkae

HA

CS

Usedin

sore

throatdiarrhea

dysenteryandvomiting

Kohat

Cassiafi

stula

LCa

esalpiniaceae

Amaltas

TP

CF

Apieceo

fthe

fruitcon

taining

10ndash12seedsa

reslightly

grou

ndandbo

iledin

12liter

ofwater

andstr

ainedford

ysentery

1-2teas

poon

s3tim

esdaily

for1-2

days

3-4teas

poon

s3-4tim

esdaily

DIK

han

Bann

u

Cedrus

deodara(Roxbex

D

Don

)GD

onPinaceae

Diar

TA

CWhpl

Gas

troub

les

Karak

Cinn

amom

umzeylanicu

mBlum

eLauraceae

Dalchini

TP

CBa

Bark

powdera

nddecoctionis

used

ingastrointestinaldisorder

vomiting

dysenteryand

diarrhea

Asn

eeded

Asn

eeded

Kohat

Citru

lluscolocynthis(L)Schrad

Cucurbita

ceae

Kartum

ma

HA

WF

Fruitisc

utboiledin

water

and

sugara

dded

tomakem

urabba

used

forc

onstipatio

nand

abdo

minaldiseases

Asn

eeded

Asn

eeded

DIK

han

Bann

uKo

hat

Lakk

iMarwat

Coria

ndrumsativ

umL

Apiaceae

Dhania

HA

CF

Fruitisc

rushed

andmixed

with

saltas

carm

inativeindigestion

Smallamou

ntof

safoof

2tim

esa

day

Smallamou

ntof

safoof

2tim

esa

day

DIK

han

CrotalariaburhiaBe

nth

Papilio

naceae

Sassai

SP

WWhpl

Drie

dplantisg

roun

dmixed

with

waterand

strainedandis

givenlocally

ford

iarrheaa

ndothera

bdom

inaltro

ubles

DIK

han

Curcum

alonga

LZing

iberaceae

Haldi

HA

CRh

Rhizom

epow

derise

ffectivein

stomachcancerstomach

bleeding

Not

used

still

Asn

eeded

Kohat

Cyperusr

otun

dusL

Cy

peraceae

Delloca

HP

WRh

Rhizom

eise

ffectiveintre

atment

ofdyspepsia

diarrheaa

ndvomiting

Asn

eeded

Asn

eeded

Bann

u

Daturastra

monium

LSolanaceae

Datura

HA

WWhpl

Seedsa

reused

forintestin

alworms

Asn

eeded

Asn

eeded

Karak

Elaeagnu

sangustifoliaL

Cactaceae

Sersang

TP

WR

SF

Con

stipatio

nLakk

iMarwat

Ephedrag

erardian

aWallex

StapfEp

hedraceae

Somane

TA

CW

ShFL

Dyspepsia

Lakk

iMarwat

EquisetumarvenseL

Eq

uisetaceae

Horsta

ilCh

ihly

HP

WWhpl

Diarrhea

Lakk

iMarwat

BioMed Research International 7

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Eugeniajambolana

Lam

Myrtaceae

Jaman

TP

CS

Forstomachprob

lemsgrindthe

seedsa

ndmakep

owder

Asn

eeded

1-2spoo

nsdaily

for3

days

Bann

u

Euphorbiah

irtaL

Euph

orbiaceae

Titra

HP

WWhpl

Stom

achpain

Lakk

iMarwat

FicusreligiosaL

Moraceae

Peepal

TP

WC

BaBu

rntheb

arkandmakep

owder

from

itTake

5gram

sofito

rally

with

water

ford

iarrhea

Asn

eeded

Asn

eeded

Bann

u

Foenicu

lumvulga

reMill

Apiaceae

Saun

fH

AC

F

Equalquantity

offenn

elfruit

coria

nder

fruitAn

ethu

msowa

andsugara

remixed

andgrou

ndtogether

tomakep

owderfor

dyspepsia

andabdo

minalpain

Asrequired

Twicea

dayaft

ermeal

DIK

han

Fumariaindica

(Hausskn

)Pu

gsley

Fumariaceae

Shahtera

HP

WWhpl

Itisused

inachesa

ndpains

diarrheavom

iting

Asn

eeded

Asn

eeded

Kohat

Lyciu

mbarbarum

LSolanaceae

SP

WL

Extractfrom

leaves

iseffectiv

ein

curin

gbloo

dydiarrhea

and

vomiting

Asn

eeded

Asn

eeded

Bann

u

Malva

negle

ctaWallr

Malvaceae

Panerak

HP

WSh

Stom

achpain

Lakk

iMarwat

Malva

parvifloraL

Malvaceae

Puskay

HP

WL

Decoctio

nof

leaves

isused

for

stomachprob

lemItisa

lsoused

aslaxativ

eNot

used

Asneeded

Karak

Meliaa

zadirachtaL

Meliaceae

DharekBa

kain

TP

CW

LF

Leaves

andfruitd

ecoctio

nis

used

toremoveintestin

alworms

Littlea

mou

ntis

given

more

dosage

cause

vomiting

Asn

eededmore

dosage

cause

vomiting

Lakk

iMarwat

Menthalongifolia

(L)L

Lamiaceae

Villanaypo

dina

HA

CWhpl

Freshleaves

areb

oiledin

water

with

greenteam

ixed

somes

ugar

tocure

diarrhea

2teas

poon

safte

r3ho

ursfor

1day

4teas

poon

safte

r3ho

ursfor

1day

Kohat

Lakk

iMarwat

KarakDI

Khan

Nastu

rtium

officin

aleR

Br

Brassic

aceae

Term

era

HP

WWhpl

Leaves

aretaken

orallyfor

constip

ation

Asn

eeded

Asn

eeded

DIK

han

Opuntiadillenii(Ke

rGaw

l)Haw

Cactaceae

Kund

athu

rS

PW

LF

Ripenedfruitisb

oiledin

water

addsomes

ugar

andtake

orally

forc

onstipatio

nAsn

eeded

Asn

eeded

DIK

han

Opu

ntiamonacantha(W

illd)

Haw

Cactaceae

Chnu

tarthar

SP

WWhpl

Digestio

nhelp

DIK

han

Oxalis

cornicu

lata

LOxalid

aceae

Tarookay

HP

WL

Extractjuice

from

fresh

leaves

useo

rally

againststomach

troub

les

Asn

eeded

Asn

eeded

Bann

u

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

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[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 2: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

2 BioMed Research International

Shigella spp Salmonella spp Aeromonas spp Pseudomonasspp Campylobacter spp Klebsiella spp and Staphylococcusaureus [10] However antibiotic resistance is a major clinicalproblem in treating infections caused by these microor-ganisms Synthetic drugs such as proton pump inhibitorsH2 receptors cytoprotectants demulcents anticholinergicsantacids and prostaglandin analogues are used for the treat-ment of gastro problems but these drugs produce several sideeffects Herbal remedies are considered as better alternativesfor the treatment For example proton pump inhibitors(omeprazole lansoprazole) may cause nausea abdominalpain constipation and diarrhea and H2 receptor antagonists(cimetidine)may cause gynaecomastia and loss of libido Dueto the occurrence of many side effects by use of syntheticdrugs for many diseases medicinal plants are considered asthe main source of new drugs as they have less or no sideeffects Herbal medicines are considered as safe with lesseradverse effects economical effective relatively less toxic andextensive research is carried out in search for potent drugs ofplant origin [11] In Pakistan and other countries a variety ofmedicinal plants are used against gastrointestinal complaintssuch as diarrhea dysentery and cholera However manyof them have not been screened for their phytochemistryand pharmacological action against microbes which couldsupport their use in traditional medicines

The present study was the first effort to target gastroin-testinal infections and their traditional recipes in five remotesouthern regions of Khyber Pakhtunkhwa province of Pak-istan where these infections were found more common Themain purpose of the study was to conserve the ethnomedic-inal knowledge and to select candidate medicinal plants forfurther phytochemical and pharmacological investigationThe available literature shows that such studies can constitutethe starting point for the development of new drugs [12 13]Our efforts are towards not only providing nutrition andhealth care to the people but also recovering record anddiffuse local botanical knowledge and traditional wisdom

2 Material and Methods21 Study Area The present study was conducted in fivemajor remote areas (Dera Ismail Khan Bannu LakkiMarwatand Karak and Kohat) of Khyber Pakhtunkhwa province ofPakistan (Figure 1) D I Khan is an area of 7326 squarekilometers and is situated between 31∘151015840 and 32∘321015840N latitudeand between 70∘111015840 and 71∘201015840E longitude Most of the areaof D I Khan is flat dry alluvial plains supporting mostlyxerophytic vegetation Dominant plant species are Acaciamodesta Acacia nilotica Calotropis procera Morus albaand Eucalyptus camaldulensis Most of the population ofthe area is rural with low literacy rate and they also lackmodern health facilities hence they are more dependentupon natural resources especially plants for their healthcareand to compensate their low income as well [14] Bannuconsists of a total area of 877 square kilometers with apopulation of 19593 It lies within the Karakoram mountainrange between 32∘43 to 33∘06N latitude and 73∘20 to 70∘07Elongitude The total cultivated area is about 33000 acreswith wheat maize and sugarcane being the main cultivated

crops About 25 of the inhabitants of the area as well asAfghan refugees are engaged in the collection and marketingof medicinal plantsThe area consists of alluvial plain with anannual rainfall of 11136mm The dominant plant species areAcaciamodestaAcacia niloticaCalotropis proceraDodonaeaviscosa andWithania somnifera [15] Karak region is situatedin the south of KPK with total area of 600 square kilometersand lies between 70-40∘ to 71-30∘N latitude and 32-48∘ to 33-23∘E longitude The study area is divided into mountainousarea small hills and plains having most of clayey or sandysoil Wheat corn and gram are the common cultivatedcrops Various plant species dominated the study area suchas Acacia modesta Acacia nilotica Adhatoda vasica Aervajavanica Dodonaea viscosa Eucalyptus lanceolatus Fagoniacretica Rhazya stricta Saccharum arundinaceum Withaniacoagulans and Withania somnifera [16] Kohat is located at33∘35101584013N 71∘26101584029E with an altitude of 489m above sealevel The dominant vegetation of the study area is Zizyphusspecies Acacia species and other xerophytes plants The areais rural in nature and inhabitants are very much dependenton plants for agricultural economic and food purposesLocals of the region use a variety of medicinal plants for thetreatment of various ailments due to expensivemodern drugs[17] Lakki Marwat is situated between 32∘161N latitude and70∘191E longitude at altitude of 200ndash1000m above sea levelThis district covers an area of 3164 km2 with a cultivated areaof approximately 116900 ha The indigenous people of thedistrict are Marwat tribes but a small proportion of othertribes also settled here Transport and minerals are the mainsources of economy in the urban area and agriculture is theprimary livelihood of the rural population The major ethnicgroup in this district speaks Pashto (993) which is spokenin a specific dialect [18] The remaining population speaksPunjabi (07) in Hindko dialect

22 Sampling and Data Collection Data collection was car-ried out from 2013 to 2014 Prior to data collection localadministrative officers of the regions were visited and it wasexplained them themain idea of the study in order to get theirpermission According to the information provided by thelocal administrative officers 350 respondents were selectedin five studied region with 70 informants in each regionThe selection criterion of informants was mainly based ontheir rich indigenous knowledge and long term experienceof utilization of plants as well as their living period of timein the study area Selected respondents of the regions wereaged between 30 and 79 years Verbal consent includingconsent for publication was received from all the informantsbefore the interviews began The informants are aware thatthe information they have provided will be published andthat data will be used only for scientific purposes Data wascollected in local language (Saraiki Hindko and Pashto) andconverted into English Semistructured questionnaires weredesigned to collect ethnomedicinal knowledge of medicinalplants used against gastrointestinal infections

23 Plants Collection and Identification Plants were collectedwith the help of respondents from wild and cultivated areasCollected voucher specimens were taken to the Herbarium

BioMed Research International 3

Afghanistan

Charikar

Jalalabad

Khyber Agency

Kabul

Gardeyz

Khowst

SharZarghun North

SouthWaziristan

Balochistan

WaziristanRazmak

Miranshah

Wana

Jandola

LakkiMarwat

Tank

Zhob

Dera IsmailKhan

Dera

KhanIsmail

Bannu

Karak

Hangu

KurramAgency

ParachinarLandi

MohmandAgency

Kotal

Orakzai Agency

KohatKohat

Mianwali

Kalabagh

Panjab

Pakistan

Islamabad

Murree

India

BajaurAgency

DirDir

Swat

Shangla

Mansehra

Chitral

Chitral

Mastuj

Mt Tirich MirMor Khun

Northern Areas

Gilgit

AgencyMalakand

Nowshera

Charsadda

Peshawar

MardanSwabi

Buner

HaripurAbbottabad

Tajikistan

Kalam DasuKohistan

SaiduSharif

Naran

MansehraBattagram

Figure 1

of Kohat University of Science and Technology (KUST)Kohat Pakistan Specimen identification and confirmationwere undertaken by using Flora of Pakistan and taxonomicexperts Specimens with their label were stored at theHerbar-ium of KUST Kohat Pakistan

24 Data Organization The collected data on ethno medic-inal plants and ethnography of the respondents was orga-nized using Microsoft Excel 2007 and summarized usinggraphical statistical methods such as percentages The habitof the plants was categorized into 3 classes (herbs shrubsand trees) Life form of medicinal plants was classified

into annual biennial and perennial Plant parts use wascategorized into leaves roots stem whole plant seedsfruit and flower Stomach disorders were divided into sixmajor categories that is diarrhea dysentery abdominal painintestinal worms constipation and nausea and vomiting

25 Data Quality Assurance Each respondent was ap-proached at least three times during data collection for 5 thelegitimacy of information they provided Information wasconsidered irrelevant and rejected in case of any divergencefrom the original information of the respondent Valid datawas only subjected to further analysis process Further data

4 BioMed Research International

quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis

26 Data Analysis

261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows

Fic = nur minus ntnur minus 1

(1)

where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used

262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula

FL = IpIutimes 100 (2)

where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]

3 Results

In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred

plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)

Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)

Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives

4 Discussion

41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]

42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs

BioMed Research International 5Ta

ble1Medicinaluses

ofplantsforstomachtro

ubles

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Abutilonindicum

(L)Sw

eet

Malvaceae

Koso

beta

SA

WWhpl

Decoctio

nor

powderisu

sed

againstcon

stipatio

n1tea

spoo

naft

ermeal

2ndash4teas

poon

saft

ermeal

Lakk

iMarwat

Acaciamodesta

Wall

Mim

osaceae

Phulahi

TP

WBa

Decoctio

nismadeb

ybo

iling

bark

inwater

orpo

wdero

fbark

ismadeb

ygrinding

theb

arkfor

treatmento

fgas

troub

leand

abdo

minaldiseases

2spoo

nsaft

er4h

rsfor1

day

3-4spoo

nsaft

er2h

rsfor2

days

ordepend

son

severity

DIK

han

Acacianilotica(L)Delile

Mim

osaceae

Kikar

TP

WPo

Ba

Decoctio

nof

theb

arkisused

indiarrhea

andpo

dsareg

rindedto

makep

owderm

ixed

with

sugar

orho

neyto

treatdysentery

Smallamou

ntof

powderisg

iven

for1-2

days

500m

ggiven

twicea

dayfor3

days

Kohat

Achyranthesa

speraL

Amaranthaceae

Gho

shkai

HP

WWhpl

Itsdecoctionisused

insto

mach

disorderTh

ejuice

ofthep

lant

isused

inabdo

minalpain

dysenteryandin

bowel

complaints

Depends

ondiseases

everity

Depends

ondiseases

everity

Bann

u

Albizialebbeck

(L)Be

nth

Mim

osaceae

Sirin

TP

CBa

Bark

decoctionisused

totre

atdiarrhea

1-2spoo

n3tim

esad

ay1-2

spoo

naft

er3h

rsfor1

day

Bann

u

Alliu

mcepa

LLiliaceae

Piaz

HA

CBu

Equalamou

ntso

fextractof

onionbu

lbandmintare

mixed

andgivenforc

holera

Halftea

spoo

nof

thismixture

istakenperh

our

fora

perio

das

needed

One

teas

poon

ofthismixture

istakenperh

our

fora

perio

das

needed

DIK

han

Argyrolobium

roseum

(Cam

bess)

Jaub

ampSpach

Nyctaginaceae

Muk

hanBu

tti

SB

WWhpl

Diarrhea

Bann

u

Artemisiaa

bsinthium

LAs

teraceae

Afsanteen

HB

WL

Leaves

areb

oiledto

expel

intestinalwormsindigestion

diarrheaand

vomiting

Asn

eeded

Asn

eeded

Kohat

Asparagusadscend

ensR

oxb

Asparagaceae

Safid

muesli

HA

WR

Groun

droot

iseffectiv

efor

carm

inative

Asn

eeded

Asn

eeded

Karak

Azadira

chta

indica

AJuss

Meliaceae

Neem

TP

CL

Decoctio

nof

leaves

istakenfor

digestivea

ndgastric

prob

lems

2teas

poon

sfor

oned

ay2teas

poon

sfor

oned

ay

DIK

han

Lakk

iMarwat

Bisto

rtaam

plexica

ulis(D

Don

)Greene

Polygonaceae

Masloon

Anjabar

HP

WWhpl

Con

stipatio

nBa

nnu

Kohat

Boerhaavia

diffu

saBrandegee

Nyctaginaceae

Punara

HP

WR

Gas

troub

les

Karak

Camelliasin

ensis

(green

tea)

LKu

ntze

Theaceae

Sabz

pati

HP

CL

Leaves

areb

oiledin

water

mixed

somes

ugar

andtake

orallyfor

indigestionandnausea

1orh

alfcup

once

aday

1cup

aday

DIK

han

Bann

uLakk

iMarwat

6 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Carissa

opacaStapfex

Haines

Apocyn

aceae

Grand

aS

AWC

LR

FDysentery

Karak

Carumcopticu

m(L)Be

nthamp

Hoo

kfex

CB

Clarke

Umbelliferae

Spaerkae

HA

CS

Usedin

sore

throatdiarrhea

dysenteryandvomiting

Kohat

Cassiafi

stula

LCa

esalpiniaceae

Amaltas

TP

CF

Apieceo

fthe

fruitcon

taining

10ndash12seedsa

reslightly

grou

ndandbo

iledin

12liter

ofwater

andstr

ainedford

ysentery

1-2teas

poon

s3tim

esdaily

for1-2

days

3-4teas

poon

s3-4tim

esdaily

DIK

han

Bann

u

Cedrus

deodara(Roxbex

D

Don

)GD

onPinaceae

Diar

TA

CWhpl

Gas

troub

les

Karak

Cinn

amom

umzeylanicu

mBlum

eLauraceae

Dalchini

TP

CBa

Bark

powdera

nddecoctionis

used

ingastrointestinaldisorder

vomiting

dysenteryand

diarrhea

Asn

eeded

Asn

eeded

Kohat

Citru

lluscolocynthis(L)Schrad

Cucurbita

ceae

Kartum

ma

HA

WF

Fruitisc

utboiledin

water

and

sugara

dded

tomakem

urabba

used

forc

onstipatio

nand

abdo

minaldiseases

Asn

eeded

Asn

eeded

DIK

han

Bann

uKo

hat

Lakk

iMarwat

Coria

ndrumsativ

umL

Apiaceae

Dhania

HA

CF

Fruitisc

rushed

andmixed

with

saltas

carm

inativeindigestion

Smallamou

ntof

safoof

2tim

esa

day

Smallamou

ntof

safoof

2tim

esa

day

DIK

han

CrotalariaburhiaBe

nth

Papilio

naceae

Sassai

SP

WWhpl

Drie

dplantisg

roun

dmixed

with

waterand

strainedandis

givenlocally

ford

iarrheaa

ndothera

bdom

inaltro

ubles

DIK

han

Curcum

alonga

LZing

iberaceae

Haldi

HA

CRh

Rhizom

epow

derise

ffectivein

stomachcancerstomach

bleeding

Not

used

still

Asn

eeded

Kohat

Cyperusr

otun

dusL

Cy

peraceae

Delloca

HP

WRh

Rhizom

eise

ffectiveintre

atment

ofdyspepsia

diarrheaa

ndvomiting

Asn

eeded

Asn

eeded

Bann

u

Daturastra

monium

LSolanaceae

Datura

HA

WWhpl

Seedsa

reused

forintestin

alworms

Asn

eeded

Asn

eeded

Karak

Elaeagnu

sangustifoliaL

Cactaceae

Sersang

TP

WR

SF

Con

stipatio

nLakk

iMarwat

Ephedrag

erardian

aWallex

StapfEp

hedraceae

Somane

TA

CW

ShFL

Dyspepsia

Lakk

iMarwat

EquisetumarvenseL

Eq

uisetaceae

Horsta

ilCh

ihly

HP

WWhpl

Diarrhea

Lakk

iMarwat

BioMed Research International 7

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Eugeniajambolana

Lam

Myrtaceae

Jaman

TP

CS

Forstomachprob

lemsgrindthe

seedsa

ndmakep

owder

Asn

eeded

1-2spoo

nsdaily

for3

days

Bann

u

Euphorbiah

irtaL

Euph

orbiaceae

Titra

HP

WWhpl

Stom

achpain

Lakk

iMarwat

FicusreligiosaL

Moraceae

Peepal

TP

WC

BaBu

rntheb

arkandmakep

owder

from

itTake

5gram

sofito

rally

with

water

ford

iarrhea

Asn

eeded

Asn

eeded

Bann

u

Foenicu

lumvulga

reMill

Apiaceae

Saun

fH

AC

F

Equalquantity

offenn

elfruit

coria

nder

fruitAn

ethu

msowa

andsugara

remixed

andgrou

ndtogether

tomakep

owderfor

dyspepsia

andabdo

minalpain

Asrequired

Twicea

dayaft

ermeal

DIK

han

Fumariaindica

(Hausskn

)Pu

gsley

Fumariaceae

Shahtera

HP

WWhpl

Itisused

inachesa

ndpains

diarrheavom

iting

Asn

eeded

Asn

eeded

Kohat

Lyciu

mbarbarum

LSolanaceae

SP

WL

Extractfrom

leaves

iseffectiv

ein

curin

gbloo

dydiarrhea

and

vomiting

Asn

eeded

Asn

eeded

Bann

u

Malva

negle

ctaWallr

Malvaceae

Panerak

HP

WSh

Stom

achpain

Lakk

iMarwat

Malva

parvifloraL

Malvaceae

Puskay

HP

WL

Decoctio

nof

leaves

isused

for

stomachprob

lemItisa

lsoused

aslaxativ

eNot

used

Asneeded

Karak

Meliaa

zadirachtaL

Meliaceae

DharekBa

kain

TP

CW

LF

Leaves

andfruitd

ecoctio

nis

used

toremoveintestin

alworms

Littlea

mou

ntis

given

more

dosage

cause

vomiting

Asn

eededmore

dosage

cause

vomiting

Lakk

iMarwat

Menthalongifolia

(L)L

Lamiaceae

Villanaypo

dina

HA

CWhpl

Freshleaves

areb

oiledin

water

with

greenteam

ixed

somes

ugar

tocure

diarrhea

2teas

poon

safte

r3ho

ursfor

1day

4teas

poon

safte

r3ho

ursfor

1day

Kohat

Lakk

iMarwat

KarakDI

Khan

Nastu

rtium

officin

aleR

Br

Brassic

aceae

Term

era

HP

WWhpl

Leaves

aretaken

orallyfor

constip

ation

Asn

eeded

Asn

eeded

DIK

han

Opuntiadillenii(Ke

rGaw

l)Haw

Cactaceae

Kund

athu

rS

PW

LF

Ripenedfruitisb

oiledin

water

addsomes

ugar

andtake

orally

forc

onstipatio

nAsn

eeded

Asn

eeded

DIK

han

Opu

ntiamonacantha(W

illd)

Haw

Cactaceae

Chnu

tarthar

SP

WWhpl

Digestio

nhelp

DIK

han

Oxalis

cornicu

lata

LOxalid

aceae

Tarookay

HP

WL

Extractjuice

from

fresh

leaves

useo

rally

againststomach

troub

les

Asn

eeded

Asn

eeded

Bann

u

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 3: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

BioMed Research International 3

Afghanistan

Charikar

Jalalabad

Khyber Agency

Kabul

Gardeyz

Khowst

SharZarghun North

SouthWaziristan

Balochistan

WaziristanRazmak

Miranshah

Wana

Jandola

LakkiMarwat

Tank

Zhob

Dera IsmailKhan

Dera

KhanIsmail

Bannu

Karak

Hangu

KurramAgency

ParachinarLandi

MohmandAgency

Kotal

Orakzai Agency

KohatKohat

Mianwali

Kalabagh

Panjab

Pakistan

Islamabad

Murree

India

BajaurAgency

DirDir

Swat

Shangla

Mansehra

Chitral

Chitral

Mastuj

Mt Tirich MirMor Khun

Northern Areas

Gilgit

AgencyMalakand

Nowshera

Charsadda

Peshawar

MardanSwabi

Buner

HaripurAbbottabad

Tajikistan

Kalam DasuKohistan

SaiduSharif

Naran

MansehraBattagram

Figure 1

of Kohat University of Science and Technology (KUST)Kohat Pakistan Specimen identification and confirmationwere undertaken by using Flora of Pakistan and taxonomicexperts Specimens with their label were stored at theHerbar-ium of KUST Kohat Pakistan

24 Data Organization The collected data on ethno medic-inal plants and ethnography of the respondents was orga-nized using Microsoft Excel 2007 and summarized usinggraphical statistical methods such as percentages The habitof the plants was categorized into 3 classes (herbs shrubsand trees) Life form of medicinal plants was classified

into annual biennial and perennial Plant parts use wascategorized into leaves roots stem whole plant seedsfruit and flower Stomach disorders were divided into sixmajor categories that is diarrhea dysentery abdominal painintestinal worms constipation and nausea and vomiting

25 Data Quality Assurance Each respondent was ap-proached at least three times during data collection for 5 thelegitimacy of information they provided Information wasconsidered irrelevant and rejected in case of any divergencefrom the original information of the respondent Valid datawas only subjected to further analysis process Further data

4 BioMed Research International

quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis

26 Data Analysis

261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows

Fic = nur minus ntnur minus 1

(1)

where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used

262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula

FL = IpIutimes 100 (2)

where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]

3 Results

In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred

plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)

Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)

Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives

4 Discussion

41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]

42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs

BioMed Research International 5Ta

ble1Medicinaluses

ofplantsforstomachtro

ubles

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Abutilonindicum

(L)Sw

eet

Malvaceae

Koso

beta

SA

WWhpl

Decoctio

nor

powderisu

sed

againstcon

stipatio

n1tea

spoo

naft

ermeal

2ndash4teas

poon

saft

ermeal

Lakk

iMarwat

Acaciamodesta

Wall

Mim

osaceae

Phulahi

TP

WBa

Decoctio

nismadeb

ybo

iling

bark

inwater

orpo

wdero

fbark

ismadeb

ygrinding

theb

arkfor

treatmento

fgas

troub

leand

abdo

minaldiseases

2spoo

nsaft

er4h

rsfor1

day

3-4spoo

nsaft

er2h

rsfor2

days

ordepend

son

severity

DIK

han

Acacianilotica(L)Delile

Mim

osaceae

Kikar

TP

WPo

Ba

Decoctio

nof

theb

arkisused

indiarrhea

andpo

dsareg

rindedto

makep

owderm

ixed

with

sugar

orho

neyto

treatdysentery

Smallamou

ntof

powderisg

iven

for1-2

days

500m

ggiven

twicea

dayfor3

days

Kohat

Achyranthesa

speraL

Amaranthaceae

Gho

shkai

HP

WWhpl

Itsdecoctionisused

insto

mach

disorderTh

ejuice

ofthep

lant

isused

inabdo

minalpain

dysenteryandin

bowel

complaints

Depends

ondiseases

everity

Depends

ondiseases

everity

Bann

u

Albizialebbeck

(L)Be

nth

Mim

osaceae

Sirin

TP

CBa

Bark

decoctionisused

totre

atdiarrhea

1-2spoo

n3tim

esad

ay1-2

spoo

naft

er3h

rsfor1

day

Bann

u

Alliu

mcepa

LLiliaceae

Piaz

HA

CBu

Equalamou

ntso

fextractof

onionbu

lbandmintare

mixed

andgivenforc

holera

Halftea

spoo

nof

thismixture

istakenperh

our

fora

perio

das

needed

One

teas

poon

ofthismixture

istakenperh

our

fora

perio

das

needed

DIK

han

Argyrolobium

roseum

(Cam

bess)

Jaub

ampSpach

Nyctaginaceae

Muk

hanBu

tti

SB

WWhpl

Diarrhea

Bann

u

Artemisiaa

bsinthium

LAs

teraceae

Afsanteen

HB

WL

Leaves

areb

oiledto

expel

intestinalwormsindigestion

diarrheaand

vomiting

Asn

eeded

Asn

eeded

Kohat

Asparagusadscend

ensR

oxb

Asparagaceae

Safid

muesli

HA

WR

Groun

droot

iseffectiv

efor

carm

inative

Asn

eeded

Asn

eeded

Karak

Azadira

chta

indica

AJuss

Meliaceae

Neem

TP

CL

Decoctio

nof

leaves

istakenfor

digestivea

ndgastric

prob

lems

2teas

poon

sfor

oned

ay2teas

poon

sfor

oned

ay

DIK

han

Lakk

iMarwat

Bisto

rtaam

plexica

ulis(D

Don

)Greene

Polygonaceae

Masloon

Anjabar

HP

WWhpl

Con

stipatio

nBa

nnu

Kohat

Boerhaavia

diffu

saBrandegee

Nyctaginaceae

Punara

HP

WR

Gas

troub

les

Karak

Camelliasin

ensis

(green

tea)

LKu

ntze

Theaceae

Sabz

pati

HP

CL

Leaves

areb

oiledin

water

mixed

somes

ugar

andtake

orallyfor

indigestionandnausea

1orh

alfcup

once

aday

1cup

aday

DIK

han

Bann

uLakk

iMarwat

6 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Carissa

opacaStapfex

Haines

Apocyn

aceae

Grand

aS

AWC

LR

FDysentery

Karak

Carumcopticu

m(L)Be

nthamp

Hoo

kfex

CB

Clarke

Umbelliferae

Spaerkae

HA

CS

Usedin

sore

throatdiarrhea

dysenteryandvomiting

Kohat

Cassiafi

stula

LCa

esalpiniaceae

Amaltas

TP

CF

Apieceo

fthe

fruitcon

taining

10ndash12seedsa

reslightly

grou

ndandbo

iledin

12liter

ofwater

andstr

ainedford

ysentery

1-2teas

poon

s3tim

esdaily

for1-2

days

3-4teas

poon

s3-4tim

esdaily

DIK

han

Bann

u

Cedrus

deodara(Roxbex

D

Don

)GD

onPinaceae

Diar

TA

CWhpl

Gas

troub

les

Karak

Cinn

amom

umzeylanicu

mBlum

eLauraceae

Dalchini

TP

CBa

Bark

powdera

nddecoctionis

used

ingastrointestinaldisorder

vomiting

dysenteryand

diarrhea

Asn

eeded

Asn

eeded

Kohat

Citru

lluscolocynthis(L)Schrad

Cucurbita

ceae

Kartum

ma

HA

WF

Fruitisc

utboiledin

water

and

sugara

dded

tomakem

urabba

used

forc

onstipatio

nand

abdo

minaldiseases

Asn

eeded

Asn

eeded

DIK

han

Bann

uKo

hat

Lakk

iMarwat

Coria

ndrumsativ

umL

Apiaceae

Dhania

HA

CF

Fruitisc

rushed

andmixed

with

saltas

carm

inativeindigestion

Smallamou

ntof

safoof

2tim

esa

day

Smallamou

ntof

safoof

2tim

esa

day

DIK

han

CrotalariaburhiaBe

nth

Papilio

naceae

Sassai

SP

WWhpl

Drie

dplantisg

roun

dmixed

with

waterand

strainedandis

givenlocally

ford

iarrheaa

ndothera

bdom

inaltro

ubles

DIK

han

Curcum

alonga

LZing

iberaceae

Haldi

HA

CRh

Rhizom

epow

derise

ffectivein

stomachcancerstomach

bleeding

Not

used

still

Asn

eeded

Kohat

Cyperusr

otun

dusL

Cy

peraceae

Delloca

HP

WRh

Rhizom

eise

ffectiveintre

atment

ofdyspepsia

diarrheaa

ndvomiting

Asn

eeded

Asn

eeded

Bann

u

Daturastra

monium

LSolanaceae

Datura

HA

WWhpl

Seedsa

reused

forintestin

alworms

Asn

eeded

Asn

eeded

Karak

Elaeagnu

sangustifoliaL

Cactaceae

Sersang

TP

WR

SF

Con

stipatio

nLakk

iMarwat

Ephedrag

erardian

aWallex

StapfEp

hedraceae

Somane

TA

CW

ShFL

Dyspepsia

Lakk

iMarwat

EquisetumarvenseL

Eq

uisetaceae

Horsta

ilCh

ihly

HP

WWhpl

Diarrhea

Lakk

iMarwat

BioMed Research International 7

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Eugeniajambolana

Lam

Myrtaceae

Jaman

TP

CS

Forstomachprob

lemsgrindthe

seedsa

ndmakep

owder

Asn

eeded

1-2spoo

nsdaily

for3

days

Bann

u

Euphorbiah

irtaL

Euph

orbiaceae

Titra

HP

WWhpl

Stom

achpain

Lakk

iMarwat

FicusreligiosaL

Moraceae

Peepal

TP

WC

BaBu

rntheb

arkandmakep

owder

from

itTake

5gram

sofito

rally

with

water

ford

iarrhea

Asn

eeded

Asn

eeded

Bann

u

Foenicu

lumvulga

reMill

Apiaceae

Saun

fH

AC

F

Equalquantity

offenn

elfruit

coria

nder

fruitAn

ethu

msowa

andsugara

remixed

andgrou

ndtogether

tomakep

owderfor

dyspepsia

andabdo

minalpain

Asrequired

Twicea

dayaft

ermeal

DIK

han

Fumariaindica

(Hausskn

)Pu

gsley

Fumariaceae

Shahtera

HP

WWhpl

Itisused

inachesa

ndpains

diarrheavom

iting

Asn

eeded

Asn

eeded

Kohat

Lyciu

mbarbarum

LSolanaceae

SP

WL

Extractfrom

leaves

iseffectiv

ein

curin

gbloo

dydiarrhea

and

vomiting

Asn

eeded

Asn

eeded

Bann

u

Malva

negle

ctaWallr

Malvaceae

Panerak

HP

WSh

Stom

achpain

Lakk

iMarwat

Malva

parvifloraL

Malvaceae

Puskay

HP

WL

Decoctio

nof

leaves

isused

for

stomachprob

lemItisa

lsoused

aslaxativ

eNot

used

Asneeded

Karak

Meliaa

zadirachtaL

Meliaceae

DharekBa

kain

TP

CW

LF

Leaves

andfruitd

ecoctio

nis

used

toremoveintestin

alworms

Littlea

mou

ntis

given

more

dosage

cause

vomiting

Asn

eededmore

dosage

cause

vomiting

Lakk

iMarwat

Menthalongifolia

(L)L

Lamiaceae

Villanaypo

dina

HA

CWhpl

Freshleaves

areb

oiledin

water

with

greenteam

ixed

somes

ugar

tocure

diarrhea

2teas

poon

safte

r3ho

ursfor

1day

4teas

poon

safte

r3ho

ursfor

1day

Kohat

Lakk

iMarwat

KarakDI

Khan

Nastu

rtium

officin

aleR

Br

Brassic

aceae

Term

era

HP

WWhpl

Leaves

aretaken

orallyfor

constip

ation

Asn

eeded

Asn

eeded

DIK

han

Opuntiadillenii(Ke

rGaw

l)Haw

Cactaceae

Kund

athu

rS

PW

LF

Ripenedfruitisb

oiledin

water

addsomes

ugar

andtake

orally

forc

onstipatio

nAsn

eeded

Asn

eeded

DIK

han

Opu

ntiamonacantha(W

illd)

Haw

Cactaceae

Chnu

tarthar

SP

WWhpl

Digestio

nhelp

DIK

han

Oxalis

cornicu

lata

LOxalid

aceae

Tarookay

HP

WL

Extractjuice

from

fresh

leaves

useo

rally

againststomach

troub

les

Asn

eeded

Asn

eeded

Bann

u

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

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[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 4: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

4 BioMed Research International

quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis

26 Data Analysis

261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows

Fic = nur minus ntnur minus 1

(1)

where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used

262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula

FL = IpIutimes 100 (2)

where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]

3 Results

In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred

plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)

Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)

Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives

4 Discussion

41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]

42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs

BioMed Research International 5Ta

ble1Medicinaluses

ofplantsforstomachtro

ubles

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Abutilonindicum

(L)Sw

eet

Malvaceae

Koso

beta

SA

WWhpl

Decoctio

nor

powderisu

sed

againstcon

stipatio

n1tea

spoo

naft

ermeal

2ndash4teas

poon

saft

ermeal

Lakk

iMarwat

Acaciamodesta

Wall

Mim

osaceae

Phulahi

TP

WBa

Decoctio

nismadeb

ybo

iling

bark

inwater

orpo

wdero

fbark

ismadeb

ygrinding

theb

arkfor

treatmento

fgas

troub

leand

abdo

minaldiseases

2spoo

nsaft

er4h

rsfor1

day

3-4spoo

nsaft

er2h

rsfor2

days

ordepend

son

severity

DIK

han

Acacianilotica(L)Delile

Mim

osaceae

Kikar

TP

WPo

Ba

Decoctio

nof

theb

arkisused

indiarrhea

andpo

dsareg

rindedto

makep

owderm

ixed

with

sugar

orho

neyto

treatdysentery

Smallamou

ntof

powderisg

iven

for1-2

days

500m

ggiven

twicea

dayfor3

days

Kohat

Achyranthesa

speraL

Amaranthaceae

Gho

shkai

HP

WWhpl

Itsdecoctionisused

insto

mach

disorderTh

ejuice

ofthep

lant

isused

inabdo

minalpain

dysenteryandin

bowel

complaints

Depends

ondiseases

everity

Depends

ondiseases

everity

Bann

u

Albizialebbeck

(L)Be

nth

Mim

osaceae

Sirin

TP

CBa

Bark

decoctionisused

totre

atdiarrhea

1-2spoo

n3tim

esad

ay1-2

spoo

naft

er3h

rsfor1

day

Bann

u

Alliu

mcepa

LLiliaceae

Piaz

HA

CBu

Equalamou

ntso

fextractof

onionbu

lbandmintare

mixed

andgivenforc

holera

Halftea

spoo

nof

thismixture

istakenperh

our

fora

perio

das

needed

One

teas

poon

ofthismixture

istakenperh

our

fora

perio

das

needed

DIK

han

Argyrolobium

roseum

(Cam

bess)

Jaub

ampSpach

Nyctaginaceae

Muk

hanBu

tti

SB

WWhpl

Diarrhea

Bann

u

Artemisiaa

bsinthium

LAs

teraceae

Afsanteen

HB

WL

Leaves

areb

oiledto

expel

intestinalwormsindigestion

diarrheaand

vomiting

Asn

eeded

Asn

eeded

Kohat

Asparagusadscend

ensR

oxb

Asparagaceae

Safid

muesli

HA

WR

Groun

droot

iseffectiv

efor

carm

inative

Asn

eeded

Asn

eeded

Karak

Azadira

chta

indica

AJuss

Meliaceae

Neem

TP

CL

Decoctio

nof

leaves

istakenfor

digestivea

ndgastric

prob

lems

2teas

poon

sfor

oned

ay2teas

poon

sfor

oned

ay

DIK

han

Lakk

iMarwat

Bisto

rtaam

plexica

ulis(D

Don

)Greene

Polygonaceae

Masloon

Anjabar

HP

WWhpl

Con

stipatio

nBa

nnu

Kohat

Boerhaavia

diffu

saBrandegee

Nyctaginaceae

Punara

HP

WR

Gas

troub

les

Karak

Camelliasin

ensis

(green

tea)

LKu

ntze

Theaceae

Sabz

pati

HP

CL

Leaves

areb

oiledin

water

mixed

somes

ugar

andtake

orallyfor

indigestionandnausea

1orh

alfcup

once

aday

1cup

aday

DIK

han

Bann

uLakk

iMarwat

6 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Carissa

opacaStapfex

Haines

Apocyn

aceae

Grand

aS

AWC

LR

FDysentery

Karak

Carumcopticu

m(L)Be

nthamp

Hoo

kfex

CB

Clarke

Umbelliferae

Spaerkae

HA

CS

Usedin

sore

throatdiarrhea

dysenteryandvomiting

Kohat

Cassiafi

stula

LCa

esalpiniaceae

Amaltas

TP

CF

Apieceo

fthe

fruitcon

taining

10ndash12seedsa

reslightly

grou

ndandbo

iledin

12liter

ofwater

andstr

ainedford

ysentery

1-2teas

poon

s3tim

esdaily

for1-2

days

3-4teas

poon

s3-4tim

esdaily

DIK

han

Bann

u

Cedrus

deodara(Roxbex

D

Don

)GD

onPinaceae

Diar

TA

CWhpl

Gas

troub

les

Karak

Cinn

amom

umzeylanicu

mBlum

eLauraceae

Dalchini

TP

CBa

Bark

powdera

nddecoctionis

used

ingastrointestinaldisorder

vomiting

dysenteryand

diarrhea

Asn

eeded

Asn

eeded

Kohat

Citru

lluscolocynthis(L)Schrad

Cucurbita

ceae

Kartum

ma

HA

WF

Fruitisc

utboiledin

water

and

sugara

dded

tomakem

urabba

used

forc

onstipatio

nand

abdo

minaldiseases

Asn

eeded

Asn

eeded

DIK

han

Bann

uKo

hat

Lakk

iMarwat

Coria

ndrumsativ

umL

Apiaceae

Dhania

HA

CF

Fruitisc

rushed

andmixed

with

saltas

carm

inativeindigestion

Smallamou

ntof

safoof

2tim

esa

day

Smallamou

ntof

safoof

2tim

esa

day

DIK

han

CrotalariaburhiaBe

nth

Papilio

naceae

Sassai

SP

WWhpl

Drie

dplantisg

roun

dmixed

with

waterand

strainedandis

givenlocally

ford

iarrheaa

ndothera

bdom

inaltro

ubles

DIK

han

Curcum

alonga

LZing

iberaceae

Haldi

HA

CRh

Rhizom

epow

derise

ffectivein

stomachcancerstomach

bleeding

Not

used

still

Asn

eeded

Kohat

Cyperusr

otun

dusL

Cy

peraceae

Delloca

HP

WRh

Rhizom

eise

ffectiveintre

atment

ofdyspepsia

diarrheaa

ndvomiting

Asn

eeded

Asn

eeded

Bann

u

Daturastra

monium

LSolanaceae

Datura

HA

WWhpl

Seedsa

reused

forintestin

alworms

Asn

eeded

Asn

eeded

Karak

Elaeagnu

sangustifoliaL

Cactaceae

Sersang

TP

WR

SF

Con

stipatio

nLakk

iMarwat

Ephedrag

erardian

aWallex

StapfEp

hedraceae

Somane

TA

CW

ShFL

Dyspepsia

Lakk

iMarwat

EquisetumarvenseL

Eq

uisetaceae

Horsta

ilCh

ihly

HP

WWhpl

Diarrhea

Lakk

iMarwat

BioMed Research International 7

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Eugeniajambolana

Lam

Myrtaceae

Jaman

TP

CS

Forstomachprob

lemsgrindthe

seedsa

ndmakep

owder

Asn

eeded

1-2spoo

nsdaily

for3

days

Bann

u

Euphorbiah

irtaL

Euph

orbiaceae

Titra

HP

WWhpl

Stom

achpain

Lakk

iMarwat

FicusreligiosaL

Moraceae

Peepal

TP

WC

BaBu

rntheb

arkandmakep

owder

from

itTake

5gram

sofito

rally

with

water

ford

iarrhea

Asn

eeded

Asn

eeded

Bann

u

Foenicu

lumvulga

reMill

Apiaceae

Saun

fH

AC

F

Equalquantity

offenn

elfruit

coria

nder

fruitAn

ethu

msowa

andsugara

remixed

andgrou

ndtogether

tomakep

owderfor

dyspepsia

andabdo

minalpain

Asrequired

Twicea

dayaft

ermeal

DIK

han

Fumariaindica

(Hausskn

)Pu

gsley

Fumariaceae

Shahtera

HP

WWhpl

Itisused

inachesa

ndpains

diarrheavom

iting

Asn

eeded

Asn

eeded

Kohat

Lyciu

mbarbarum

LSolanaceae

SP

WL

Extractfrom

leaves

iseffectiv

ein

curin

gbloo

dydiarrhea

and

vomiting

Asn

eeded

Asn

eeded

Bann

u

Malva

negle

ctaWallr

Malvaceae

Panerak

HP

WSh

Stom

achpain

Lakk

iMarwat

Malva

parvifloraL

Malvaceae

Puskay

HP

WL

Decoctio

nof

leaves

isused

for

stomachprob

lemItisa

lsoused

aslaxativ

eNot

used

Asneeded

Karak

Meliaa

zadirachtaL

Meliaceae

DharekBa

kain

TP

CW

LF

Leaves

andfruitd

ecoctio

nis

used

toremoveintestin

alworms

Littlea

mou

ntis

given

more

dosage

cause

vomiting

Asn

eededmore

dosage

cause

vomiting

Lakk

iMarwat

Menthalongifolia

(L)L

Lamiaceae

Villanaypo

dina

HA

CWhpl

Freshleaves

areb

oiledin

water

with

greenteam

ixed

somes

ugar

tocure

diarrhea

2teas

poon

safte

r3ho

ursfor

1day

4teas

poon

safte

r3ho

ursfor

1day

Kohat

Lakk

iMarwat

KarakDI

Khan

Nastu

rtium

officin

aleR

Br

Brassic

aceae

Term

era

HP

WWhpl

Leaves

aretaken

orallyfor

constip

ation

Asn

eeded

Asn

eeded

DIK

han

Opuntiadillenii(Ke

rGaw

l)Haw

Cactaceae

Kund

athu

rS

PW

LF

Ripenedfruitisb

oiledin

water

addsomes

ugar

andtake

orally

forc

onstipatio

nAsn

eeded

Asn

eeded

DIK

han

Opu

ntiamonacantha(W

illd)

Haw

Cactaceae

Chnu

tarthar

SP

WWhpl

Digestio

nhelp

DIK

han

Oxalis

cornicu

lata

LOxalid

aceae

Tarookay

HP

WL

Extractjuice

from

fresh

leaves

useo

rally

againststomach

troub

les

Asn

eeded

Asn

eeded

Bann

u

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

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[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 5: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

BioMed Research International 5Ta

ble1Medicinaluses

ofplantsforstomachtro

ubles

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Abutilonindicum

(L)Sw

eet

Malvaceae

Koso

beta

SA

WWhpl

Decoctio

nor

powderisu

sed

againstcon

stipatio

n1tea

spoo

naft

ermeal

2ndash4teas

poon

saft

ermeal

Lakk

iMarwat

Acaciamodesta

Wall

Mim

osaceae

Phulahi

TP

WBa

Decoctio

nismadeb

ybo

iling

bark

inwater

orpo

wdero

fbark

ismadeb

ygrinding

theb

arkfor

treatmento

fgas

troub

leand

abdo

minaldiseases

2spoo

nsaft

er4h

rsfor1

day

3-4spoo

nsaft

er2h

rsfor2

days

ordepend

son

severity

DIK

han

Acacianilotica(L)Delile

Mim

osaceae

Kikar

TP

WPo

Ba

Decoctio

nof

theb

arkisused

indiarrhea

andpo

dsareg

rindedto

makep

owderm

ixed

with

sugar

orho

neyto

treatdysentery

Smallamou

ntof

powderisg

iven

for1-2

days

500m

ggiven

twicea

dayfor3

days

Kohat

Achyranthesa

speraL

Amaranthaceae

Gho

shkai

HP

WWhpl

Itsdecoctionisused

insto

mach

disorderTh

ejuice

ofthep

lant

isused

inabdo

minalpain

dysenteryandin

bowel

complaints

Depends

ondiseases

everity

Depends

ondiseases

everity

Bann

u

Albizialebbeck

(L)Be

nth

Mim

osaceae

Sirin

TP

CBa

Bark

decoctionisused

totre

atdiarrhea

1-2spoo

n3tim

esad

ay1-2

spoo

naft

er3h

rsfor1

day

Bann

u

Alliu

mcepa

LLiliaceae

Piaz

HA

CBu

Equalamou

ntso

fextractof

onionbu

lbandmintare

mixed

andgivenforc

holera

Halftea

spoo

nof

thismixture

istakenperh

our

fora

perio

das

needed

One

teas

poon

ofthismixture

istakenperh

our

fora

perio

das

needed

DIK

han

Argyrolobium

roseum

(Cam

bess)

Jaub

ampSpach

Nyctaginaceae

Muk

hanBu

tti

SB

WWhpl

Diarrhea

Bann

u

Artemisiaa

bsinthium

LAs

teraceae

Afsanteen

HB

WL

Leaves

areb

oiledto

expel

intestinalwormsindigestion

diarrheaand

vomiting

Asn

eeded

Asn

eeded

Kohat

Asparagusadscend

ensR

oxb

Asparagaceae

Safid

muesli

HA

WR

Groun

droot

iseffectiv

efor

carm

inative

Asn

eeded

Asn

eeded

Karak

Azadira

chta

indica

AJuss

Meliaceae

Neem

TP

CL

Decoctio

nof

leaves

istakenfor

digestivea

ndgastric

prob

lems

2teas

poon

sfor

oned

ay2teas

poon

sfor

oned

ay

DIK

han

Lakk

iMarwat

Bisto

rtaam

plexica

ulis(D

Don

)Greene

Polygonaceae

Masloon

Anjabar

HP

WWhpl

Con

stipatio

nBa

nnu

Kohat

Boerhaavia

diffu

saBrandegee

Nyctaginaceae

Punara

HP

WR

Gas

troub

les

Karak

Camelliasin

ensis

(green

tea)

LKu

ntze

Theaceae

Sabz

pati

HP

CL

Leaves

areb

oiledin

water

mixed

somes

ugar

andtake

orallyfor

indigestionandnausea

1orh

alfcup

once

aday

1cup

aday

DIK

han

Bann

uLakk

iMarwat

6 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Carissa

opacaStapfex

Haines

Apocyn

aceae

Grand

aS

AWC

LR

FDysentery

Karak

Carumcopticu

m(L)Be

nthamp

Hoo

kfex

CB

Clarke

Umbelliferae

Spaerkae

HA

CS

Usedin

sore

throatdiarrhea

dysenteryandvomiting

Kohat

Cassiafi

stula

LCa

esalpiniaceae

Amaltas

TP

CF

Apieceo

fthe

fruitcon

taining

10ndash12seedsa

reslightly

grou

ndandbo

iledin

12liter

ofwater

andstr

ainedford

ysentery

1-2teas

poon

s3tim

esdaily

for1-2

days

3-4teas

poon

s3-4tim

esdaily

DIK

han

Bann

u

Cedrus

deodara(Roxbex

D

Don

)GD

onPinaceae

Diar

TA

CWhpl

Gas

troub

les

Karak

Cinn

amom

umzeylanicu

mBlum

eLauraceae

Dalchini

TP

CBa

Bark

powdera

nddecoctionis

used

ingastrointestinaldisorder

vomiting

dysenteryand

diarrhea

Asn

eeded

Asn

eeded

Kohat

Citru

lluscolocynthis(L)Schrad

Cucurbita

ceae

Kartum

ma

HA

WF

Fruitisc

utboiledin

water

and

sugara

dded

tomakem

urabba

used

forc

onstipatio

nand

abdo

minaldiseases

Asn

eeded

Asn

eeded

DIK

han

Bann

uKo

hat

Lakk

iMarwat

Coria

ndrumsativ

umL

Apiaceae

Dhania

HA

CF

Fruitisc

rushed

andmixed

with

saltas

carm

inativeindigestion

Smallamou

ntof

safoof

2tim

esa

day

Smallamou

ntof

safoof

2tim

esa

day

DIK

han

CrotalariaburhiaBe

nth

Papilio

naceae

Sassai

SP

WWhpl

Drie

dplantisg

roun

dmixed

with

waterand

strainedandis

givenlocally

ford

iarrheaa

ndothera

bdom

inaltro

ubles

DIK

han

Curcum

alonga

LZing

iberaceae

Haldi

HA

CRh

Rhizom

epow

derise

ffectivein

stomachcancerstomach

bleeding

Not

used

still

Asn

eeded

Kohat

Cyperusr

otun

dusL

Cy

peraceae

Delloca

HP

WRh

Rhizom

eise

ffectiveintre

atment

ofdyspepsia

diarrheaa

ndvomiting

Asn

eeded

Asn

eeded

Bann

u

Daturastra

monium

LSolanaceae

Datura

HA

WWhpl

Seedsa

reused

forintestin

alworms

Asn

eeded

Asn

eeded

Karak

Elaeagnu

sangustifoliaL

Cactaceae

Sersang

TP

WR

SF

Con

stipatio

nLakk

iMarwat

Ephedrag

erardian

aWallex

StapfEp

hedraceae

Somane

TA

CW

ShFL

Dyspepsia

Lakk

iMarwat

EquisetumarvenseL

Eq

uisetaceae

Horsta

ilCh

ihly

HP

WWhpl

Diarrhea

Lakk

iMarwat

BioMed Research International 7

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Eugeniajambolana

Lam

Myrtaceae

Jaman

TP

CS

Forstomachprob

lemsgrindthe

seedsa

ndmakep

owder

Asn

eeded

1-2spoo

nsdaily

for3

days

Bann

u

Euphorbiah

irtaL

Euph

orbiaceae

Titra

HP

WWhpl

Stom

achpain

Lakk

iMarwat

FicusreligiosaL

Moraceae

Peepal

TP

WC

BaBu

rntheb

arkandmakep

owder

from

itTake

5gram

sofito

rally

with

water

ford

iarrhea

Asn

eeded

Asn

eeded

Bann

u

Foenicu

lumvulga

reMill

Apiaceae

Saun

fH

AC

F

Equalquantity

offenn

elfruit

coria

nder

fruitAn

ethu

msowa

andsugara

remixed

andgrou

ndtogether

tomakep

owderfor

dyspepsia

andabdo

minalpain

Asrequired

Twicea

dayaft

ermeal

DIK

han

Fumariaindica

(Hausskn

)Pu

gsley

Fumariaceae

Shahtera

HP

WWhpl

Itisused

inachesa

ndpains

diarrheavom

iting

Asn

eeded

Asn

eeded

Kohat

Lyciu

mbarbarum

LSolanaceae

SP

WL

Extractfrom

leaves

iseffectiv

ein

curin

gbloo

dydiarrhea

and

vomiting

Asn

eeded

Asn

eeded

Bann

u

Malva

negle

ctaWallr

Malvaceae

Panerak

HP

WSh

Stom

achpain

Lakk

iMarwat

Malva

parvifloraL

Malvaceae

Puskay

HP

WL

Decoctio

nof

leaves

isused

for

stomachprob

lemItisa

lsoused

aslaxativ

eNot

used

Asneeded

Karak

Meliaa

zadirachtaL

Meliaceae

DharekBa

kain

TP

CW

LF

Leaves

andfruitd

ecoctio

nis

used

toremoveintestin

alworms

Littlea

mou

ntis

given

more

dosage

cause

vomiting

Asn

eededmore

dosage

cause

vomiting

Lakk

iMarwat

Menthalongifolia

(L)L

Lamiaceae

Villanaypo

dina

HA

CWhpl

Freshleaves

areb

oiledin

water

with

greenteam

ixed

somes

ugar

tocure

diarrhea

2teas

poon

safte

r3ho

ursfor

1day

4teas

poon

safte

r3ho

ursfor

1day

Kohat

Lakk

iMarwat

KarakDI

Khan

Nastu

rtium

officin

aleR

Br

Brassic

aceae

Term

era

HP

WWhpl

Leaves

aretaken

orallyfor

constip

ation

Asn

eeded

Asn

eeded

DIK

han

Opuntiadillenii(Ke

rGaw

l)Haw

Cactaceae

Kund

athu

rS

PW

LF

Ripenedfruitisb

oiledin

water

addsomes

ugar

andtake

orally

forc

onstipatio

nAsn

eeded

Asn

eeded

DIK

han

Opu

ntiamonacantha(W

illd)

Haw

Cactaceae

Chnu

tarthar

SP

WWhpl

Digestio

nhelp

DIK

han

Oxalis

cornicu

lata

LOxalid

aceae

Tarookay

HP

WL

Extractjuice

from

fresh

leaves

useo

rally

againststomach

troub

les

Asn

eeded

Asn

eeded

Bann

u

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 6: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

6 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Carissa

opacaStapfex

Haines

Apocyn

aceae

Grand

aS

AWC

LR

FDysentery

Karak

Carumcopticu

m(L)Be

nthamp

Hoo

kfex

CB

Clarke

Umbelliferae

Spaerkae

HA

CS

Usedin

sore

throatdiarrhea

dysenteryandvomiting

Kohat

Cassiafi

stula

LCa

esalpiniaceae

Amaltas

TP

CF

Apieceo

fthe

fruitcon

taining

10ndash12seedsa

reslightly

grou

ndandbo

iledin

12liter

ofwater

andstr

ainedford

ysentery

1-2teas

poon

s3tim

esdaily

for1-2

days

3-4teas

poon

s3-4tim

esdaily

DIK

han

Bann

u

Cedrus

deodara(Roxbex

D

Don

)GD

onPinaceae

Diar

TA

CWhpl

Gas

troub

les

Karak

Cinn

amom

umzeylanicu

mBlum

eLauraceae

Dalchini

TP

CBa

Bark

powdera

nddecoctionis

used

ingastrointestinaldisorder

vomiting

dysenteryand

diarrhea

Asn

eeded

Asn

eeded

Kohat

Citru

lluscolocynthis(L)Schrad

Cucurbita

ceae

Kartum

ma

HA

WF

Fruitisc

utboiledin

water

and

sugara

dded

tomakem

urabba

used

forc

onstipatio

nand

abdo

minaldiseases

Asn

eeded

Asn

eeded

DIK

han

Bann

uKo

hat

Lakk

iMarwat

Coria

ndrumsativ

umL

Apiaceae

Dhania

HA

CF

Fruitisc

rushed

andmixed

with

saltas

carm

inativeindigestion

Smallamou

ntof

safoof

2tim

esa

day

Smallamou

ntof

safoof

2tim

esa

day

DIK

han

CrotalariaburhiaBe

nth

Papilio

naceae

Sassai

SP

WWhpl

Drie

dplantisg

roun

dmixed

with

waterand

strainedandis

givenlocally

ford

iarrheaa

ndothera

bdom

inaltro

ubles

DIK

han

Curcum

alonga

LZing

iberaceae

Haldi

HA

CRh

Rhizom

epow

derise

ffectivein

stomachcancerstomach

bleeding

Not

used

still

Asn

eeded

Kohat

Cyperusr

otun

dusL

Cy

peraceae

Delloca

HP

WRh

Rhizom

eise

ffectiveintre

atment

ofdyspepsia

diarrheaa

ndvomiting

Asn

eeded

Asn

eeded

Bann

u

Daturastra

monium

LSolanaceae

Datura

HA

WWhpl

Seedsa

reused

forintestin

alworms

Asn

eeded

Asn

eeded

Karak

Elaeagnu

sangustifoliaL

Cactaceae

Sersang

TP

WR

SF

Con

stipatio

nLakk

iMarwat

Ephedrag

erardian

aWallex

StapfEp

hedraceae

Somane

TA

CW

ShFL

Dyspepsia

Lakk

iMarwat

EquisetumarvenseL

Eq

uisetaceae

Horsta

ilCh

ihly

HP

WWhpl

Diarrhea

Lakk

iMarwat

BioMed Research International 7

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Eugeniajambolana

Lam

Myrtaceae

Jaman

TP

CS

Forstomachprob

lemsgrindthe

seedsa

ndmakep

owder

Asn

eeded

1-2spoo

nsdaily

for3

days

Bann

u

Euphorbiah

irtaL

Euph

orbiaceae

Titra

HP

WWhpl

Stom

achpain

Lakk

iMarwat

FicusreligiosaL

Moraceae

Peepal

TP

WC

BaBu

rntheb

arkandmakep

owder

from

itTake

5gram

sofito

rally

with

water

ford

iarrhea

Asn

eeded

Asn

eeded

Bann

u

Foenicu

lumvulga

reMill

Apiaceae

Saun

fH

AC

F

Equalquantity

offenn

elfruit

coria

nder

fruitAn

ethu

msowa

andsugara

remixed

andgrou

ndtogether

tomakep

owderfor

dyspepsia

andabdo

minalpain

Asrequired

Twicea

dayaft

ermeal

DIK

han

Fumariaindica

(Hausskn

)Pu

gsley

Fumariaceae

Shahtera

HP

WWhpl

Itisused

inachesa

ndpains

diarrheavom

iting

Asn

eeded

Asn

eeded

Kohat

Lyciu

mbarbarum

LSolanaceae

SP

WL

Extractfrom

leaves

iseffectiv

ein

curin

gbloo

dydiarrhea

and

vomiting

Asn

eeded

Asn

eeded

Bann

u

Malva

negle

ctaWallr

Malvaceae

Panerak

HP

WSh

Stom

achpain

Lakk

iMarwat

Malva

parvifloraL

Malvaceae

Puskay

HP

WL

Decoctio

nof

leaves

isused

for

stomachprob

lemItisa

lsoused

aslaxativ

eNot

used

Asneeded

Karak

Meliaa

zadirachtaL

Meliaceae

DharekBa

kain

TP

CW

LF

Leaves

andfruitd

ecoctio

nis

used

toremoveintestin

alworms

Littlea

mou

ntis

given

more

dosage

cause

vomiting

Asn

eededmore

dosage

cause

vomiting

Lakk

iMarwat

Menthalongifolia

(L)L

Lamiaceae

Villanaypo

dina

HA

CWhpl

Freshleaves

areb

oiledin

water

with

greenteam

ixed

somes

ugar

tocure

diarrhea

2teas

poon

safte

r3ho

ursfor

1day

4teas

poon

safte

r3ho

ursfor

1day

Kohat

Lakk

iMarwat

KarakDI

Khan

Nastu

rtium

officin

aleR

Br

Brassic

aceae

Term

era

HP

WWhpl

Leaves

aretaken

orallyfor

constip

ation

Asn

eeded

Asn

eeded

DIK

han

Opuntiadillenii(Ke

rGaw

l)Haw

Cactaceae

Kund

athu

rS

PW

LF

Ripenedfruitisb

oiledin

water

addsomes

ugar

andtake

orally

forc

onstipatio

nAsn

eeded

Asn

eeded

DIK

han

Opu

ntiamonacantha(W

illd)

Haw

Cactaceae

Chnu

tarthar

SP

WWhpl

Digestio

nhelp

DIK

han

Oxalis

cornicu

lata

LOxalid

aceae

Tarookay

HP

WL

Extractjuice

from

fresh

leaves

useo

rally

againststomach

troub

les

Asn

eeded

Asn

eeded

Bann

u

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 7: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

BioMed Research International 7

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Eugeniajambolana

Lam

Myrtaceae

Jaman

TP

CS

Forstomachprob

lemsgrindthe

seedsa

ndmakep

owder

Asn

eeded

1-2spoo

nsdaily

for3

days

Bann

u

Euphorbiah

irtaL

Euph

orbiaceae

Titra

HP

WWhpl

Stom

achpain

Lakk

iMarwat

FicusreligiosaL

Moraceae

Peepal

TP

WC

BaBu

rntheb

arkandmakep

owder

from

itTake

5gram

sofito

rally

with

water

ford

iarrhea

Asn

eeded

Asn

eeded

Bann

u

Foenicu

lumvulga

reMill

Apiaceae

Saun

fH

AC

F

Equalquantity

offenn

elfruit

coria

nder

fruitAn

ethu

msowa

andsugara

remixed

andgrou

ndtogether

tomakep

owderfor

dyspepsia

andabdo

minalpain

Asrequired

Twicea

dayaft

ermeal

DIK

han

Fumariaindica

(Hausskn

)Pu

gsley

Fumariaceae

Shahtera

HP

WWhpl

Itisused

inachesa

ndpains

diarrheavom

iting

Asn

eeded

Asn

eeded

Kohat

Lyciu

mbarbarum

LSolanaceae

SP

WL

Extractfrom

leaves

iseffectiv

ein

curin

gbloo

dydiarrhea

and

vomiting

Asn

eeded

Asn

eeded

Bann

u

Malva

negle

ctaWallr

Malvaceae

Panerak

HP

WSh

Stom

achpain

Lakk

iMarwat

Malva

parvifloraL

Malvaceae

Puskay

HP

WL

Decoctio

nof

leaves

isused

for

stomachprob

lemItisa

lsoused

aslaxativ

eNot

used

Asneeded

Karak

Meliaa

zadirachtaL

Meliaceae

DharekBa

kain

TP

CW

LF

Leaves

andfruitd

ecoctio

nis

used

toremoveintestin

alworms

Littlea

mou

ntis

given

more

dosage

cause

vomiting

Asn

eededmore

dosage

cause

vomiting

Lakk

iMarwat

Menthalongifolia

(L)L

Lamiaceae

Villanaypo

dina

HA

CWhpl

Freshleaves

areb

oiledin

water

with

greenteam

ixed

somes

ugar

tocure

diarrhea

2teas

poon

safte

r3ho

ursfor

1day

4teas

poon

safte

r3ho

ursfor

1day

Kohat

Lakk

iMarwat

KarakDI

Khan

Nastu

rtium

officin

aleR

Br

Brassic

aceae

Term

era

HP

WWhpl

Leaves

aretaken

orallyfor

constip

ation

Asn

eeded

Asn

eeded

DIK

han

Opuntiadillenii(Ke

rGaw

l)Haw

Cactaceae

Kund

athu

rS

PW

LF

Ripenedfruitisb

oiledin

water

addsomes

ugar

andtake

orally

forc

onstipatio

nAsn

eeded

Asn

eeded

DIK

han

Opu

ntiamonacantha(W

illd)

Haw

Cactaceae

Chnu

tarthar

SP

WWhpl

Digestio

nhelp

DIK

han

Oxalis

cornicu

lata

LOxalid

aceae

Tarookay

HP

WL

Extractjuice

from

fresh

leaves

useo

rally

againststomach

troub

les

Asn

eeded

Asn

eeded

Bann

u

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 8: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

8 BioMed Research International

Table1Con

tinued

Plantand

family

name

Localn

ame

Habit

Life-span

Planto

ccurrence

status

Partused

Usesa

ndrecipes

Dosagea

ndrecovery

Place

Child

ren

Adults

Phyllanthus

emblica

Phyllanthaceae

Amla

TP

WF

Effectiv

eindiarrhea

dysentery

Kohat

Punica

granatum

LPu

nicaceae

Anar

TP

CF

Outer

coverin

gof

fruitisd

ried

andcrushedandpo

wderistaken

with

water

ford

iarrhea

One

tables

poon

daily

for2

-3days

One

tables

poon

daily

for2

-3days

DIK

han

Rosaindica

LRo

saceae

Gulab

SP

CFl

Flow

erarem

ixed

with

sugarp

utin

sunplacetakeo

rally

with

water

andfenn

elforv

omiting

anddyspepsia

2gtwicea

day

5gtwicea

day

DIK

han

Bann

uKo

hat

Saccharumoffi

cinarum

LPo

aceae

Gana

SA

CSt

Stem

extractisu

sefulin

indigestion

Twicea

day

Twicea

day

DIK

han

Lakk

iMarwat

Bann

uSisymbriumirioLinn

Brassic

aceae

Shon

opy

HA

WL

Leaves

areu

sedforstomach

prob

lems

Asn

eeded

Asn

eeded

Karak

Solanu

msuratte

nseB

urmF

Solanaceae

Manragh

onay

HB

WF

Fruitisd

riedcrushedand

powderistaken

fora

bdom

enpain

andgastroub

leAsn

eeded

Asn

eeded

Bann

uKo

hat

Tordylium

nodosum

LAp

iaceae

Hosobeta

HA

WWhpl

Intestinalw

orms

Bann

u

With

ania

coagulan

s(Stocks)

Dun

alSolanaceae

KhapyangaPaneer

HA

WFL

Fruitsarec

rushedm

ixwith

salt

andtake

orallywith

water

for

gastric

andabdo

minalpain

Fruitsares

tained

inwater

and

taken

Extracto

fleavesisu

sed

Twicea

dayfor

2-3days

Thric

eadayfor

3-4days

Karak

KohatD

IKhan

Lakk

iMarwat

Bann

uWoodfordiafru

ticosa(L)Ku

rzLythraceae

Dhawai

SP

WC

FlItisused

indiarrheadysentery

ulcersand

UTI

Kohat

Zizip

husjujub

aMill

Rham

naceae

Jang

libera

TP

WC

F

Roastthe

fruitand

eatfor

the

treatmento

fstomachprob

lems

Take

5gram

sofroo

tpow

dera

nd7pieces

ofblackpepp

ergrin

dandmixused

tocure

diarrhea

andabdo

minalpain

Smallamou

nttwicea

day

400m

gthric

eadayfor3

days

Bann

uD

IKhan

Lakk

iMarwat

Zizip

husn

ummularia

(Burmf)Wight

ampArn

Rham

naceae

Bair

TP

CF

Decoctio

nof

leaves

andbark

isused

indysentery

Asn

eeded

Take

orallythric

ead

ayfor3

-4days

Bann

uD

IKhan

Kohat

Ttre

eSshrubHherbPperenn

ialA

ann

ualB

bienn

ialW

wild

Ccultiv

atedFfruitLleavesFlflo

werW

hPlw

holeplantStstemShshoo

tBa

barkSseedR

roo

tRh

rhizomePo

pod

sandBu

bulb

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 9: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

BioMed Research International 9

Table 2 Habit life-span and parts used of medicinal plants

General attributes Total plants ageHabit

Herb 26 50Tree 16 31Shrub 10 19

Life-spanPerennial 32 62Annual 17 33Biennial 3 6

Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2

Growth formWild 35 60Cultivated 23 40

Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]

43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting

44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal

pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]

45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 10: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

10 BioMed Research International

Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions

S number Diseasecategory Plant species Number of

taxa (Nt)Number of usereports (Nur) FIC

1 Vomiting andnausea

Artemisia absinthium (5) Camellia sinensis (20) Carum copticum (10)Cinnamomum zeylanicum (5) Cyperus rotundus (4) Foeniculum vulgare (25)Lycium barbarum (8) and Rosa indica (12)

8 89 092

2 Abdominalpain

Achyranthes aspera (3) Artemisia absinthium (8) Asparagus adscendens(6) Citrullus colocynthis (16) Crotalaria burhia (3) Foeniculum vulgare (10)Solanum surattense (10) Camellia sinensis (20) Coriandrum sativum (5)Opuntia monacantha (3)Withania coagulans (31) Ziziphus jujuba (13)Azadirachta indica (13) Boerhaavia diffusa (5) Cinnamomum zeylanicum (4)Cyperus rotundus (5) Ephedra gerardiana(4) Foeniculum vulgare (8)Rosa indica (15) and Saccharum officinarum (9)

20 191 09

3 Diarrhea

Acacia nilotica (5) Albizia lebbeck (8) Allium cepa (10) Argyrolobium roseum(6) Artemisia absinthium (7) Carum copticum (9) Cinnamomum zeylanicum(3) Crotalaria burhia (8) Cyperus rotundus (6) Equisetum arvense (5)Ficus religiosa (8) Foeniculum vulgare (10) Lycium barbarum (5)Mentha longifolia (30) Ziziphus jujube (18) Phyllanthus emblica (5)Punica granatum (8) andWoodfordia fruticosa (5)

18 156 089

4 DysenteryAchyranthes aspera (5) Carissa opaca (8) Carum copticum (8) Cassia fistula(22) Cinnamomum zeylanicum (3) Phyllanthus emblica (5)Woodfordia fruticosa (5) Ziziphus nummularia (13)

8 69 089

5 Intestinalworms

Artemisia absinthium (6) Datura stramonium (7)Melia azadirachta (9) andTordylium nodosum (3) 4 25 087

6 ConstipationAbutilon indicum (3) Acacia nilotica (5) Bistorta amplexicaulis (5)Citrullus colocynthis (16) Elaeagnus angustifolia (4) Nasturtium officinale (7)and Opuntia dillenii (5)

7 45 086

Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category

S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72

effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers

46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole

is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 11: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

BioMed Research International 11

Table 5 Demographic profile of the informants

Demographic characters Total PercentageGender

Male 200 57Female 150 43

Age groups21ndash29 30 930ndash39 60 1740ndash49 100 2950ndash59 90 2560ndash69 40 1170ndash79 30 9

EducationIlliterate 155 44Primary 85 24Middle 50 14Secondary 45 13University 15 4

OccupationFemale

House wives 80 23Primary teachers 50 14Secondary teachers 20 6

MalesFarmers 90 26Shopkeepers 40 11Labourers 50 14School teachers 20 6

tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]

47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium

is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments

48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines

49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 12: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

12 BioMed Research International

410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms

5 Conclusions

Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments

Conflict of Interests

The authors declare that they have no competing interests

Authorsrsquo Contribution

Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper

Acknowledgments

The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014

References

[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006

[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958

[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007

[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003

[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011

[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991

[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993

[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993

[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993

[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009

[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005

[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013

[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011

[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014

[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014

[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013

[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 13: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

BioMed Research International 13

[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014

[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009

[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005

[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986

[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013

[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009

[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009

[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014

[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013

[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013

[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013

[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014

[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of

Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012

[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011

[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010

[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007

[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013

[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012

[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012

[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010

[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013

[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002

[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003

[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988

[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011

[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002

[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006

[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008

Page 14: Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal Complaints · 2016-05-10 · Ethnomedicinal Evaluation of Medicinal Plants Used against Gastrointestinal

14 BioMed Research International

[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009

[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990

[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006

[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011

[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003

[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012

[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012

[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012

[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012

[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003

[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008


İnce Bağırsakta Gastrointestinal Stromal Tümör, Servikal

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Generic medicinal product portfolio from a regulatory …dgra.de/media/pdf/studium/masterthesis/master_weyand_o.pdfGeneric medicinal product portfolio from a regulatory and Business

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;5G51=>-AB>;>2K5 8 ?@8@>4=K5 AB>;>2K5. ˝5B>4K … › files › terriss › gost_23268_2-91.pdf˛0720=85 =0 0=3;89A:>

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