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Snakebites and ethnobotany in the northwest region of Colombia
Journal of Ethnopharmacology 71 (2000) 493 – 504 www.elsevier.com/locate/jethpharm
Snakebites and ethnobotany in the northwest region of Colombia Part I: Traditional use of plants R. Otero a,b,*, R. Fonnegra a, S.L. Jime´nez a, V. Nu´n˜ez a, N. Evans a, S.P. Alzate a, M.E. Garcı´a a, M. Saldarriaga a, G. Del Valle a, R.G. Osorio a, A. Dı´az a, R. Valderrama a, A. Duque a, H.N. Ve´lez a b
a Programa de Ofidismo, Facultad de Medicina, Uni6ersidad de Antioquia, A.A. 1226, Medellı´n, Colombia Departamento de Pediatrı´a, Facultad de Medicina, Uni6ersidad de Antioquia, A.A. 1226, Medellı´n, Colombia
Received 10 June 1999; received in revised form 5 April 2000; accepted 15 April 2000
Abstract In Antioquia and Choco´, traditional healers attend 60% of snakebites. With the aim to produce an inventory of the plants used by the healers to treat snakebites and to document the methods of preparation, administration, the dosage, number of patients treated throughout their years of practice with treatment results, 20 healers with experience in Bothrops, Porthidium and Bothriechis envenomations were interviewed between August, 1996 and November, 1998. They belong to nine black and three indigenous rural communities located near the towns of Bojaya´, Vigı´a del Fuerte, Unguı´a (Atrato river valley), Nuquı´ and Bahı´a Solano (Pacific coast). Based on field interviews, 101 species of plants were identified as used to treat snakebites. The part used of each plant varies according to the species. Sixty plants are used in the form of drinks prepared by infusion, decoction or maceration; 78 as external baths on the affected extremity; 11 for steam application and 39 for poultices; the latter is used mainly when the bite is complicated by local necrosis. In mild and moderate envenomations, they generally use a mixture of three plants, while in severe cases they mix from five to 12, a handful of each one. Treatment is generally performed for 1–3 days, when the patient reacts positively. They reported to have treated 454 patients during their years of experience, 20 of them (4.4%) died. With the guidance of the healers, 77 species of plants were collected and photographed. These plants belong to 41 families, of which Piperaceae (13 species), Araceae (six species), Asteraceae (five species) and Gesneriaceae (three species) have the highest number of species. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Snakebites; Ethnobotany; Colombia
* Corresponding author: Tel.: + 57-4-2631914; fax: + 57-4-2638282. E-mail address: [email protected] (R. Otero). 0378-8741/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 7 8 - 8 7 4 1 ( 0 0 ) 0 0 2 4 3 - 9
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1. Introduction In Antioquia and Choco´, northwestern Colombia, from 500 to 700 snakebites are reported every year, 90% of which are bites by Bothrops, Porthidium and Bothriechis snakes, with a mortality rate of 5% and sequelae in 6% of patients (Otero et al., 1992a). Three percent of the 6 million inhabitants, consist of dispersed indigenous rural communities belonging to Indian Tribes Embera, Katı´os, Wounaan and Cuna. Epidemiological data indicate that at least 50% of snakebites are inflicted by Bothrops atrox asper (Mapana´ equis in Spanish; Dama´ in Embera; Tapa in Cuna), while 40% by Porthidium nasutum (Patoco, Veinticuatro in Spanish and Embera; Tugu in Cuna), Bothrops punctatus (Mapana´ tigre, Rabo de chucha in Spanish) and Bothriechis schlegelii, listed in order of importance (Fig. 1). Despite the fact that serotherapy was discovered 100 years ago (Bon, 1996), antivenoms are not available in all rural communities of Colombia. Thus, 60% of snakebite victims are initially treated by traditional healers (curanderos or
shamans) using medicinal plants in different forms, according to the clinical condition of the patient (Otero et al., 1992a,b, 1996; Otero-Patin˜o et al., 1998). Remote locations and difficult geographic conditions make it difficult to carry victims to the hospitals, thus, resulting in delays in medical treatment of most cases. The present study was performed with the aim of producing an inventory of the plants used by traditional healers to treat snakebites in the northwest region of Colombia, and to document the experience of these healers as regards methods of preparation, administration, dosage and results of treatment.
2. Materials and methods
2.1. Study area Rural communities located near towns in the Departments of Antioquia and Choco´ were selected as study sites due to the prevalence of traditional medicine practices in the treatment of
Fig. 1. Pitvipers that inflict 90% of snakebites in Antioquia and Choco´. (A) B. atrox asper; (B) P. nasutum; (C) B. punctatus; (D) B. schlegelii.
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495
Fig. 2. Study area. Towns and rural communities visited (O). Bojaya´ (Bellavista, La Loma, La Vuelta, Pogue), Vigı´a del Fuerte (Murrı´, Vuelta Cortada), Unguı´a (Arquı´a, Raicero, Gilgal, Titumate, Balboa) and Riosucio (Los Katios National Park) in the Atrato River valley. Nuquı´ (Jurubida´, Puerto Indio) and Bahı´a Solano (Utrı´a National Park, El Valle, Boroboro, Pozamansa) in the Pacific coast.
snakebites (Otero et al., 1992a). These communities include Bojaya´ (Bellavista, La Loma, La Vuelta, Pogue), Vigı´a del Fuerte (Murrı´, Vuelta Cortada), Unguı´a (Arquı´a, Raicero, Gilgal, Titumate, Balboa) and Riosucio (Los Katı´os National Park) in the Atrato river valley, and Nuquı´ (Jurubida´, Puerto Indio) and Bahı´a Solano (Utrı´a National Park, El Valle, Boroboro, Pozamansa) in the Pacific coast (Fig. 2).
2.2. Inter6iew and plants collection Interviews were held with traditional healers in all sites selected during two visits of 6 days duration each in every place, and data were recorded. These data include, age of healer, years of experience in the treatment of viper bites and number of patients treated during that time, plants and part used, methods of extract preparation, dose, route
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496
of administration, duration of treatment and occurrence of deaths. All healers recognized through pictures the venomous snake species that inhabit the study area. They also know that viper bites induce local signs such as swelling, hemorrhage, necrosis and life-threatening systemic signs, such as hemorrhage at a distance from the bite site, shock, and renal failure. Together with the healers, plants were collected and photographed, and brought to Medellin for identification at the Herbarium of the University of Antioquia (HUA). A set of voucher specimens are in deposit at this herbarium.
venomation (swelling and local hemorrhage). A total of 454 patients had been treated, 20 of them (4.4%) died (Table 1). Most cases were bites by B. atrox asper, based on memory recollection of healers. Ten patients with severe envenomation and complications (hemorrhage, anuria, extensive necrosis or unconsciousness) were reported and were delivered to local hospitals in nearby towns, but the final outcome was not known. Two of the shamans said that they also had experience in treating Bothrops bites in cattle and horses.
3.1. Ethnobotanical treatment 2.3. Statistical analysis A database was prepared with the information provided by shamans and healers and the data were analyzed using the computer program STATGRAPHICS 5.0 (STSC, Inc., Rockville, MD).
3. Results Twenty shamans and traditional healers were interviewed between August, 1996 and November, 1998. These individuals belong to nine black and three indigenous rural communities (Embera and Cuna ethnic groups) in the study area. The majority of these healers had extensive experience (5 – 60 years) in treatment of Bothrops and Porthidium bites. Only two of the healers had treated a few patients bitten by Bothriechis schlegelii and they agree that this arboreal pitviper induces mild enTable 1 Statistical data obtained from 20 traditional healers interviewed in Antioquia and Choco´ with experience in treating Bothrops, Porthidium and Bothriechis snakebites
Age (years) Years of experience Number of plant species used by everyone Patients treated (n =454) Mortality, n =20 (4.4%) a
The mode was zero.
Range
Mean 9 S.D.
31–90 5–60 5–40
579 16 26 9 16 159 9
3–60 0–6
239 19 1 9 1.8a
Based on field interviews described, 101 species of plants were identified as having been used to treat snakebites. A list of 77 of these plants, collected in the presence of the healers, is presented in Table 2. Data on common name, part used, form of use, route of administration, and voucher herbarium specimens are given. Sixty of the plants (singly or in combination) are used in the form of drinks prepared by infusion, decoction or maceration, in each case, a handful of each plant is prepared in 2 l of water. Extracts are administered one-half-a-cup three or four times a day in cases of mild and moderate envenomations, at 1-h intervals during the first day, and three to four times a day in subsequent days, in cases of severe envenomation. Seventyeight plants are used as external baths on the affected extremity, and as extracts prepared in a similar manner and administered at the same intervals as described above. The technique of application is to moisten a cloth or a hen feather with the extract and rub it on the extremity from the upper to the lower part of the edema, in order ‘to avoid venom diffusion through the blood stream’. Eleven plants are used in the form of steam application, three times a day. When a patient has local necrosis on the skin and soft tissues, the healers prepare poultices made with extracts of plants, including a handful of chopped stem bark, and crushed roots or leaves (e.g. Nicotiana tabacum), and mixing them with a small amount of ordinary salt and heated brown sugar (two
Decoction
Decoction Decoction or ethanolic extract
LF, BR, ST RH LF, BR, ST WP RH LF, BR RH WP RT WP WP LF, BR, ST
Copita de oro Huevo berraco Terciopelo Matapuerco, aviol tumat (in Cuna) Palo de la X, papayuelo, naipe kualu (in Cuna) Anturio 3 dedos, panue (in Cuna) Pos, tusilla Zaragoza, capitana, gallito, yansaguitup (in Cuna) Guaco negro Don˜a Juana Matapescado, ugla (in Cuna) Venadillo no amargo
Araceae/Philodendron tripartitum (Jacq.) Schott (RF6460) Araceae/R. oblongata Poeppig (RF 6439) Aristolochiaceae/Aristolochia grandiflora Sw. (RF 6340) Aristolochiaceae/Aristolochia pilosa H. B. K. (RF 6454) Asteraceae/Adenostemma la6enia (L.) Ktze. (RF 6247) Asteraceae/C. sil6estre (Aublet) Baill. (RF 6447) Asteraceae/E. 6alerianaefolia (Wolf.) DC. (RF 6432) Asteraceae/M. guaco H.B.K. (RF 6412) Asteraceae/N. lobata (L.) K. and R. (RF 6406) Bignoniaceae/Crescentia cujete L. (RF 6739) Bignoniaceae/Macfadyena unguiscati (L.) A. Gentry (RF 6734) Bignoniaceae/Tabebuia rosea (Bertold.) DC. (RF 6458) Bixaceae/Bixa orellana L. (RF 6485)
Decoction
WP
Pega–pega
Decoction or maceration
Decoction or ethanolic extracts Decoction
LF, BR, ST UF WP
SB LF, BR
Contragavilana, Venadillo amargo Totumo Lagartija, pega–pega.
Roble, guayaca´n rosado, guagul (in Cuna) Achiote rojo, misal kinip (in Cuna)
Decoction
Decoction
Decoction or maceration
Guaco morado, nuskı´du (in Cuna) WP
Decoction or maceration
Decoction
Decoction
Decoction
Decoction
Decoction and maceration
Decoction
Decoction
Decoction
Decoction
WP
Pitipiticorre´ (in Embera)
Form of use
Acanthaceae/J. secunda Vahl (RF 6408) Amaranthaceae/A. aspera L. (RF 6343) Apocynaceae/Allamanda cathartica L. (RF 6737) Araceae/Alocasia cucullata (Lour.) G. Don (RF 6239) Araceae/A. marmoratum Sod. (RF 6438) Araceae/D. longispatha Engl. and Krause (RF 6450) Araceae/D. croatii Zhu. (RF 6245)
Part usedb
Common Name
Family/species (voucher specimen)a
Table 2 Plants used to treat snakebites in northwestern Colombia
As drinks and external baths
As drinks and external baths
External baths
Drinks
As drinks, external baths and poultices As drinks and external baths
As drinks and external baths
As external baths, steams and poultices As drinks and external baths
As drinks and external baths
As drinks and external baths
Poultices
As drinks, external baths and poultices External baths
As drinks and external baths
As external baths and poultices
As external baths and poultices
External baths
As drinks and poultices
As drinks and external baths
Route of administration
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Common Name
Decoction Juice and macerated
Decoction
LF, BR, ST ST
LF, BR, ST Decoction
Poultices External baths
Decoction or maceration Decoction Decoction
Decoction or maceration
As drinks, external baths and poultices As drinks and external baths
Decoction
BR, ST
As drinks and external baths
Decoction or maceration
As drinks and external baths
As drinks, steams and poultices
As drinks and external baths
Decoction
Infusion
As external baths and poultices
BR, ST
BR
Decoction
BR, ST, RF Decoction BR
As drinks, external baths and poultices
As drinks, external baths and poultices External baths
As external baths and poultices
Decoction
WP
As drinks and external baths
Decoction or maceration
Decoction or ethanolic extract
SB
As external baths and poultices
Decoction or maceration
Decoction or maceration
LF, ST
As external baths and steams
Route of administration
As drinks, external baths and poultices As drinks, external baths and poultices As drinks, external baths and poultices As drinks and external baths
Decoction
Form of use
LF, BR, ST
Part usedb
Cucurbitaceae/Fe6illea cordifolia L. Calabacita, mantecona, aviata (in WP (RF 6341) Embera), uier kuadup (in Cuna) Cucurbitaceae/M. charantia L. (RF Balsamina, fruto de la culebra. LF, 6407) Euphorbiaceae/P. acuminatus Vahl Chirrinchao LF, (RF 6435) Fabaceae/D. adscendens (Sw.) DC. Amor seco, prende amor, pega–pega WP (RF 6431) Gentianaceae/I. alata (Aubl.) Maas Yerba de Ada´n LF, subsp. alata. (RF 6747) Gesneriaceae/B. sanguinea Pers. (RF Sangre de Cristo WP 6487) Gesneriaceae/C. pulcherrima Morton Sanguinaria, guaquito, WP (RF 6417) Kiduasapopoa (in Embera) Gesneriaceae/E. dianthiflora Moore Amargosa, escama de la verrugosa WP and Wilson (RF 6461) Haemodoraceae/Xiphidium caeruleum Manito de Dios, cola de babilla WP Aublet (RF 6731) Heliconiaceae/H. curtispatha Petersen Platanillo rojo, nakutagor (in Cuna) RH (RF 6486) Hymenophyllaceae/Trichomanes Helecho loro, naipe uki (in Cuna) WP elegans L.C.Rich (RF 6744) Lamiaceae/Ocimum basilicum (L.) Albahaca blanca LF, Willd. (RF 6730) Lamiaceae/H. capitata Jacquin (RF Trampolı´n, tres pelotas montan˜eras LF, 6732)
Boraginaceae/T. cuspidata H. B. K. Tuinakau¨n (in Embera) (RF 6420) Cactaceae/P. bleo (H.B.K.) DC. (RO Chupamelo´n 4) Caesalpiniaceae/B. rosademonte Berg. Florisanto, ariza´, tuksal (in Cuna) (RF 6455) Caesalpiniaceae/S. dariensis (Br. And Ambuima´fono (in Embera) R.) I. and B. (RF 6418) Convolvulaceae/I. cairica (L.) Sweet. Bejuco estrellita (RF 6738) Costaceae/C. guanaiensis Rusby. var. Can˜agria macrostrobilus (K.Sch.) Maas (RF 6251) Costaceae/C. lasius Loes. (RF 6244) Can˜agria menuda
Family/species (voucher specimen)a
Table 2 (Continued)
498 R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504
Common Name
Loganiaceae/Strychnos xinguensis Solita Krukoff (RF 6729) Loranthaceae/Struthanthus orbicularis Golondrino, matapalo (H. B. K.) Blume (RF 6422) Malvaceae/S. acuta Burm. f. (RF Escobabosa, kuala (in Cuna) 6238) Menispermaceae/O. tenacissima Diels Morna´guitup (in Cuna) (RF 6445) Monimiaceae/S. thecaphora (P. and Limoncillo de monte, costen˜o. E.) A. DC. (RF 6419) Moraceae/C. elastica Sesse´ (RF Caucho hembra 6443) Moraceae/F. nymphaeifolia Miller Matapalo, mamartup (in Cuna) (RF 6448) Passifloraceae/P. quadrangularis L. Badea, tabijo (in Embera) (RF 6415) Phytolaccaceae/Peti6eria alliacea L. Anamu´ (RF 6241) Piperaceae/P. elsana Trel. And Yun. Kiduaborogoa (in Embera) (RF 6409) Piperaceae/P. arboreum Aublet (RF Kansarimia (in Embera) 6413) Piperaceae/P. auritum H.B.K. (RF Santa Marı´a de anı´s. 6426) Piperaceae/Piper coruscans H.B.K. Cordoncillo (RF 6240) Piperaceae/Piper hispidum Sw. (RF Cordoncillo 6433) Piperaceae/P. longi6illosum T. and Y. Yerba de la verrugosa (RF 6484) Piperaceae/Piper marginatum Jacq. Deshinchadora, cordoncillo, rollera (RF 6342) (in Cuna) Piperaceae/Piper multipliner6ium C. Cordoncillo DC. (RF 6434) Piperaceae/Piper peltatum L. Santa Marı´a boba [(= Pothomorphe peltata (L.) Miquel)] RF (6441) Piperaceae/P. pulchrum C. DC. (RF Arbol de la verrugosa 6430) Piperaceae/Piper reticulatum L. (RF Cordoncillo, deshinchadora, rollera 6428) (in Cuna)
Family/species (voucher specimen)a
Table 2 (Continued)
Decoction Decoction Decoction or maceration Decoction Decoction Decoction or maceration Decoction Maceration Decoction Decoction or maceration Decoction or infusion Decoction or maceration Decoction or maceration Decoction or maceration Decoction or maceration Decoction or maceration
Decoction or maceration Decoction or maceration
LF, BR WP WP LF, BR, ST LF, BR, ST LF, BR, ST LF, BR LF, BR WP LF, BR LF, BR, ST LF, BR, ST LF, BR, ST WP LF, BR, ST LF, BR, ST LF, BR, ST
LF, BR, ST LF, BR, ST
Form of use Decoction or maceration or ethanolic extract Decoction
ST
Part usedb
As drinks, external baths and poultices As drinks, external baths and poultices
As drinks, external baths and poultices As drinks, external baths and poultices As drinks, external baths and poultices As external baths, steams and poultices As drinks, external baths and poultices As drinks, external baths and poultices As drinks, external baths and poultices
As external baths and poultices
As external baths, steams and poultices External baths
External baths
As drinks and external baths
As drinks, external baths and poultices As drinks and external baths
As drinks and external baths
As drinks and external baths
External baths
External baths
Route of administration
R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504 499
Decoction or maceration Juice
WP LF, BR, ST LF, BR, ST RF
Bichikirami (in Embera) Palito x, chamizo, dadia´to (in Embera) Boca de negro, sombrerito del diablo, ajı´ del diablo Limo´n pajarito
WP WP, MR WP, CS RF LF, BR, ST
LF, BR, ST, FR Decoction or maceration WP LF, BR, ST RH
Yerba verde del carpintero Cruceto, udupungit (in Cuna) Cedro´n Ajı´ pajarito Chucho fruteador Sauco amargo Yerba del Comeje´n Ochorro´neta (in Embera) Matandrea
Decoction or ethanolic extract
Decoction
Decoction or ethanolic extract
Decoction or maceration
Maceration
Decoction
Decoction or ethanolic extract
Decoction or ethanolic extract
Decoction
WP
Escobilla, escoba menudita
Decoction or maceration
WP
Yerba del pollo
Decoction
Decoction
As drinks and external baths
As drinks, external baths, steams and poultices As external baths and poultices
As drinks and external baths
As drinks and external baths
Drinks
As drinks and external baths
As drinks and external baths
As drinks, external baths and poultices As drinks and poultices
As drinks and external baths. Some shamans use crushed roots in poultices Poultices
As drinks, external baths and poultices As drinks and external baths
External baths
As drinks and external baths
As external baths and poultices
Route of administration
b
Voucher specimen: RF, Ramiro Fonnegra and other collectors; RO, Rafael Otero and other collectors. Part used: BR, branches; CS, crushed seeds; FR, fruits; LF, leaves; MR, mainly roots; RF, ripe fruits; RH, rhizomes; RT, roots; SB, stem bark; ST, stem; UF, unripe fruits; WP, the whole plant.
a
Scrophulariaceae/L. diffusa (L.) Wettst (RF 6488) Scrophulariaceae/S. dulcis L. (RF 6242) Selaginellaceae/S. articulata (Kunze) Spring. (RF 6457) Simaroubaceae/Q. amara L. (RF 6442) Simaroubaceae/S. cedron Planch. (RF 6449) Solanaceae/C. frutescens L. (RF 6345) Solanaceae/S. allophyllum (Miers.) Standl. (RF 6437) Solanaceae/S. nudum Dunal (RF 6429) Triuridaceae/S. purpurea Benth. (RF 6427) Verbenaceae/A. panamensis Mold. (RF 6411) Zingiberaceae/R. alpinia (Rottb.) Maas (RF 6456)
Decoction or maceration
LF, BR, ST
Costen˜o, hoja mano
Decoction
LF, BR, ST
Tortugo
Form of use
Piperaceae/Piper cf. spoliatum Yun. (RF 6462) Piperaceae/Piper tricuspe DC. (RF 6237) Polypodiaceae/P. percussa (Cav.) Hook and Grev. (RF 6410) Rubiaceae/Gonzalagunia panamensis (Cav.) Schumm. (RF 6405) Rubiaceae/Psychotria poeppigiana Muell-ARg. (RF 6246) Rutaceae/C. limon (L.) Burm.f. (RF 6736)
Part usedb
Common Name
Family/species (voucher specimen)a
Table 2 (Continued)
500 R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504
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spoonfuls). The mixture is then applied by wrapping the extremity with a long leaf (for example, an aroid leaf) or a piece of cloth. In mild or moderate envenomations, the healers generally use a mixture of three different plants in preparing the drinks and for external baths, while in severe cases they mix from five to 12 different plants. Some plants are used for a specific function, for example, as an anti-inflammatory (e.g. Piper sp. and Aristolochia sp.), as an antihemorrhagic (e.g. Gesneriaceae, Asteraceae, Rubiaceae, Acanthaceae, Loganiaceae) or as a cicatrizant (e.g. Dracontium croatii ). Seven shamans and traditional healers also use 30 – 38% (v/v) ethanolic extracts of plants. Every year, during the week before Easter, the healers prepare a mixture of different plants (up to 40) which is added to a glass bottle containing 1.0 – 1.5 l of cane firewater liquor (‘aguardiente de can˜a’). When a patient arrives at a shaman’s home, he/she initially receives one-half-a-cup of this drink; then, while the shaman goes to collect fresh plants in the forest, which will be used to prepare the medication to complete the treatment. Other traditional methods used for treating snakebites in black communities are: prayers, mouth suction, incisions, and tourniquets; an absorbent material known as ‘black stone’ may also be placed on the bite marks. Some healers treat patients with the assumption that ‘one poison neutralizes another ’. Thus, they sometimes use, as the complete treatment, drinks of lemon juice (one-half-a-cup) mixed with toxic chemical products, such as the powder of the insecticide mercurious chloride (Calomel®, 0.4 g) or three drops of antiseptic cresols (Veterina®) or fuel oil (one tea spoon), or external baths by rubbing the affected extremity with the juice of five lemons mixed with ammonia (five drops) or a small amount of potassium permanganate. Treatment is generally performed for 1 – 3 days, when the patient reacts positively. If the patient has local necrosis, poultices are continued until healing is accomplished. Eight of the 20 shamans complete the treatment by giving the patient a ritual bath in the river, while another eight administering a laxative. If the patient does not feel any dizziness, he is assumed to be cured; this is what shamans and healers believe.
501
3.2. Plant collection The 77 species of plants in Table 2 belong to 41 families, with the highest number of species distributed in the following families: Piperaceae (13); Araceae (6); Asteraceae (5); Gesneriaceae (3); Solanaceae (3); and Bignoniaceae (3).
4. Discussion and conclusions Many plants have been reported worldwide to be used by traditional healers for the treatment of snakebites. Mors (1991), Martz (1992) reported 578 species belonging to 94 families as having been used to treat snakebites, with the highest number of species recorded for the Asteraceae (9%), Leguminosae (7.8%) and Euphorbiaceae (4.5%). Houghton and Osibogun (1993) reported 781 species in 121 families, with the highest number of species recorded for the Leguminosae (60), Compositae (58) and Euphorbiaceae (42). Black and indigenous people inhabiting the region of this study have been using medicinal plants since preconquest epoch, a knowledge they inherited by oral tradition from generation to generation. In addition to native plants, species from Europe were introduced, in the same way as in Brazil and Mexico (Reyes and Jime´nez, 1995; Alvares-Pereira et al., 1996). During the eighteenth and nineteenth centuries, many plants were reputed used for the treatment of snakebites, such as species of Aristolochiaceae and Piperaceae, as well as Mikania guaco, Achyranthes aspera, Desmodium adscendens, Strychnos sp., Capsicum frutescens, Citrus limon and N. tabacum (TadeoLozano, 1808; Garcı´a, 1896). Other plants used to treat snakebites had also been reported from Colombia during the present century, such as Simaba cedron, Costus guanaiensis, Renealmia alpinia, Brownea rosademonte, Sida acuta, Scoparia dulcis and others (Florez, 1951; Abadı´a, 1977; Fonnegra and Rolda´n, 1994). After reviewing existing databases (Duke, 1998; Beckstrom-Sternberg et al., 1994) and the available literature on this topic, we are adding to the checklist 34 additional species, as follows: Aegiphila panamensis, Anthurium marmoratum,
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Fig. 3. Severe envenomation caused by B. atrox asper.
Castilla elastica, Clibadium sil6estre, Costus lasius, Dieffenbachia longispatha, D. croatii, Erechtites 6alerianaefolia, Ficus nymphaeifolia, Heliconia curtispatha, Hyptis capitata, Ipomoea cairica, Irlbachia alata, Justicia secunda, Lindernia diffusa, Odontocarya tenacissima, Peperomia elsana, Pereskia bleo, Phyllanthus acuminatus, Piper arboreum, Piper longi6illosum, Piper pulchrum, Piper spoliatum, Pleopeltis percussa, Rhodospatha oblongata, Sciaphila purpurea, Selaginella articulata, Senna dariensis, Siparuna thecaphora, Solanum allophyllum, Solanum nudum, Struthantus orbicularis, Tournefortia cuspidata and Thrichomanes elegans. Furthermore, we report in this paper 13 new plants that are used only by the indigenous communities of northwestern Colombia: A. panamensis, C. elastica, C. sil6estre, F. nymphaeifolia, J. secunda, O. tenacissima, Passiflora quadrangularis, P. elsana, P. arboreum, P. percussa, S. dariensis, S. thecaphora and T. cuspidata. Edema, local and systemic hemorrhage, blistering, myonecrosis and the alteration of blood coagulation are conspicuous effects of Bothrops envenomations (Fig. 3). Lethality can be the result of these effects as well as the overlying infection and renal failure (Rosenfeld, 1971; Otero et al.,
1992a, 1996; Otero-Patin˜o et al., 1998). Traditional healer’s treatment for snakebites is usually intended to improve the local damage (local pain, edema, necrosis) and to stop the venom-induced hemorrhage (Joly et al., 1987; Houghton and Osibogun, 1993). A combination of three or more plants is expected to produce synergism in their action. Some shamans called several plants as ‘brother plants’ (e.g. C. elastica and F. nymphaeifolia), which they use in an uneven number, with a belief that one plant would resolve the possible antagonism between pairs of plants (e.g. Quassia amara, O. tenacissima, and S. cedron; Neurolaena lobata, Momordica charantia and C. guanaiensis). Sometimes, morphological analogies (Doctrine of Signatures principle) is closely followed. For example, they use roots, stems or leaves from snake-shaped plants (such as vines or rhizomes of D. croatii ), leaves with a texture like a viper’s skin scales (such as P. longi6illosum or P. pulchrum), and plants with red-spotted or reddish leaves, flowers or fruits for treating hemorrhage (such as Columnea pulcherrima and Besleria sanguinea). Moreover, all shamans are convinced that the most effective plants are those having a bitter taste (e.g. Episcia dianthiflora or Piper auritum).
R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504
Although traditional healers or shamans are sometimes reluctant to accept failures in the treatment of snakebites, they reported 4.4% mortality during the interviews. This rate is not significantly different to that (5.0%) of previous studies performed in hospitals of the region, corresponding to patients who were initially treated by shamans, then by serotherapy in a hospital, but too late resulting in death as a consequence of cerebral hemorrhage or renal failure (Otero et al., 1992a). Because an increase of knowledge of medicinal plants can contribute to the elucidation of the rational basis of their use, and is useful in the development of low-cost phytotherapeuticals (Elisabetsky, 1991), further work that would demonstrate the presence of bioactivity and elucidate the structure of the active principles of extracts of plants described here against snake venoms, will be of great interest.
Acknowledgements We thank the staff of the hospitals, local governmental authorities, the communities in the region of study, the Direccio´n Seccional de Salud del Choco´, Ministerio del Medio Ambiente and the personnel of the Utrı´a and Katı´os National Parks for their cooperation. To the traditional healers Emiliano Palacio, Emiliano Palacio Jr., Basiliso Alvarez and Alberto Chaverra from Bojaya´, Dora Blando´n, Zoilo Sa´nchez and Rosaura Gutie´rrez from Vigı´a del Fuerte, Arnulfo Arango, Leandro Palomeque and Juan de Dios Rojas from Nuquı´, Menedesmo Valoy, Francisco Valoy, Gabriel Conde and Isidro Alvarado from Bahı´a Solano, Anı´bal Padilla, Hilario Ramı´rez, Angel Padilla, Julio Galvis, Darı´o Ma´rquez and Angel Salazar from Unguı´a we also express our thanks. Thanks go to Elizabeth Cadavid and Janeth Garcı´a for preparing the manuscript, and Mr Alex Parra for reviewing the English language of the manuscript. This project was supported by funds from the Instituto Colombiano para el Desarrollo de la Ciencia y la Tecnologı´a Francisco Jose´ de Caldas (Colciencias) and from the Universidad de Antioquia.
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References Abadı´a, G., 1977. Compendio general de folklore Colombiano. Editorial Andes, Bogota´, pp. 422 – 49. Alvares-Pereira, N., Jaccoud, R.J.S., Mors, W.B., 1996. Triaga brasilica: renewed interest in a seventeenth-century panacea. Toxicon 34, 511 – 516. Beckstrom-Sternberg, S.M., Duke, J.A., Wain, K.K., 1994. The ethnobotany database. http://probe.nalusda.gov: 8300/cgi-bin/browse/ethnobotdb (ACEDB version 4.3, July). Bon, C., 1996. The serum-therapy was discovered 100 years ago. Toxicon 34, 142 – 143. Duke, J., 1998. Phytochemical and ethnobotanical databases. http://www.ars-grin.gov/cgi-bin/duke/ethnobotuse.pl. Elisabetsky, E., 1991. Sociopolitical, economical and ethical issues in medicinal plant research. Journal of Ethnopharmacology 32, 235 – 239. Florez, L., 1951. Medicina, magia y animismo en Segovia de Antioquia. Revista de Folklore Instituto Etnolo´gico Nacional 6, 185 – 195. Fonnegra, R., Rolda´n, F.J., 1994. Simposio sobre plantas medicinales y/o to´xicas. Impredecol, Medellı´n, 241 pp. Garcı´a, E., 1896. Los ofidios venenosos del cauca. Editorial de Bouret, Paris, pp. 58 – 102. Houghton, P.J., Osibogun, I.M., 1993. Flowering plants used against snakebite. Journal of Ethnopharmacology 39, 1 – 29. Joly, L.G., Guerra, S., Se´ptimo, R., Solı´s, P.N., Correa, M., Gupta, M., Levy, S., Sandberg, F., 1987. Ethnobotanical inventory of medicinal plants used by the Guaymi Indians in Western Panama´. Part I. Journal of Ethnopharmacology 20, 145 – 171. Martz, W., 1992. Plants with a reputation against snakebite. Toxicon 30, 1131 – 1142. Mors, W.B., 1991. Economic and Medicinal Plant Research. Academic Press, New York, pp. 353 – 373. Otero, R., Tobo´n, G.S., Go´mez, L.F., Osorio, R.G., Valderrama, R., Hoyos, D., Urreta, J.E., Molina, S., Arboleda, J.J., 1992a. Accidente ofı´dico en Antioquia y Choco´. Aspectos clı´nicos y epidemiolo´gicos (March 1989 – February 1990). Acta Medica Colombiana 17, 229 – 249. Otero, R., Valderrama, R., Osorio, R.G., Posada, L.E., 1992b. Programa de atencio´n primaria del accidente ofı´dico. Una propuesta para Colombia. Iatreia 5, 96 – 102. Otero, R., Gutie´rrez, J.M., Nu´n˜ez, V., Robles, A., Estrada, R., Segura, E., Toro, M.F., Garcı´a, M.E., Dı´az, A., Ramirez, E.C., Go´mez, G., Castan˜eda, J., Moreno, M.E., 1996. A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia. Transactions of the Royal Society of Tropical Medicine and Hygiene 90, 696 – 700. Otero-Patin˜o, R., Cardoso, J.L.C., Higashi, H.G., Nu´n˜ez, V., Dı´az, A., Toro, M.F., Garcı´a, M.E., Sierra, A., Gar-
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cı´a, L.F., Moreno, A.M., Medina, M.C., Castan˜eda, N., SilvaDı´az, J.F., Murcia, M., Ca´rdenas, S.Y., Dias Da Silva, W.D., 1998. A randomized, blinded, comparative trial of one pepsin-digested and two whole IgG antivenoms for Bothrops snake bites in Uraba´, Colombia. American Journal of Tropical Medicine and Hygiene 58, 183–189. Reyes, R., Jime´nez, M., 1995. Quı´mica de las plantas alexı´teras. Interciencia 20, 257–264.
Rosenfeld, G., 1971. Symptomatology, pathology and treatment of snake bites in South America. In: Bucherl, W., Buckley, E. (Eds.), Venomous Animals and their Venoms. Academic Press, New York, pp. 345 – 381. Tadeo-Lozano, J., 1808. Memoria sobre las serpientes. In: De Caldas, F.J. (Ed.), Semanario del Nuevo Reino de Granada, Bogota´, pp. 107 – 132.
.
Snakebites and ethnobotany in the northwest region of Colombia Part I: Traditional use of plants R. Otero a,b,*, R. Fonnegra a, S.L. Jime´nez a, V. Nu´n˜ez a, N. Evans a, S.P. Alzate a, M.E. Garcı´a a, M. Saldarriaga a, G. Del Valle a, R.G. Osorio a, A. Dı´az a, R. Valderrama a, A. Duque a, H.N. Ve´lez a b
a Programa de Ofidismo, Facultad de Medicina, Uni6ersidad de Antioquia, A.A. 1226, Medellı´n, Colombia Departamento de Pediatrı´a, Facultad de Medicina, Uni6ersidad de Antioquia, A.A. 1226, Medellı´n, Colombia
Received 10 June 1999; received in revised form 5 April 2000; accepted 15 April 2000
Abstract In Antioquia and Choco´, traditional healers attend 60% of snakebites. With the aim to produce an inventory of the plants used by the healers to treat snakebites and to document the methods of preparation, administration, the dosage, number of patients treated throughout their years of practice with treatment results, 20 healers with experience in Bothrops, Porthidium and Bothriechis envenomations were interviewed between August, 1996 and November, 1998. They belong to nine black and three indigenous rural communities located near the towns of Bojaya´, Vigı´a del Fuerte, Unguı´a (Atrato river valley), Nuquı´ and Bahı´a Solano (Pacific coast). Based on field interviews, 101 species of plants were identified as used to treat snakebites. The part used of each plant varies according to the species. Sixty plants are used in the form of drinks prepared by infusion, decoction or maceration; 78 as external baths on the affected extremity; 11 for steam application and 39 for poultices; the latter is used mainly when the bite is complicated by local necrosis. In mild and moderate envenomations, they generally use a mixture of three plants, while in severe cases they mix from five to 12, a handful of each one. Treatment is generally performed for 1–3 days, when the patient reacts positively. They reported to have treated 454 patients during their years of experience, 20 of them (4.4%) died. With the guidance of the healers, 77 species of plants were collected and photographed. These plants belong to 41 families, of which Piperaceae (13 species), Araceae (six species), Asteraceae (five species) and Gesneriaceae (three species) have the highest number of species. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Snakebites; Ethnobotany; Colombia
* Corresponding author: Tel.: + 57-4-2631914; fax: + 57-4-2638282. E-mail address: [email protected] (R. Otero). 0378-8741/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 7 8 - 8 7 4 1 ( 0 0 ) 0 0 2 4 3 - 9
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1. Introduction In Antioquia and Choco´, northwestern Colombia, from 500 to 700 snakebites are reported every year, 90% of which are bites by Bothrops, Porthidium and Bothriechis snakes, with a mortality rate of 5% and sequelae in 6% of patients (Otero et al., 1992a). Three percent of the 6 million inhabitants, consist of dispersed indigenous rural communities belonging to Indian Tribes Embera, Katı´os, Wounaan and Cuna. Epidemiological data indicate that at least 50% of snakebites are inflicted by Bothrops atrox asper (Mapana´ equis in Spanish; Dama´ in Embera; Tapa in Cuna), while 40% by Porthidium nasutum (Patoco, Veinticuatro in Spanish and Embera; Tugu in Cuna), Bothrops punctatus (Mapana´ tigre, Rabo de chucha in Spanish) and Bothriechis schlegelii, listed in order of importance (Fig. 1). Despite the fact that serotherapy was discovered 100 years ago (Bon, 1996), antivenoms are not available in all rural communities of Colombia. Thus, 60% of snakebite victims are initially treated by traditional healers (curanderos or
shamans) using medicinal plants in different forms, according to the clinical condition of the patient (Otero et al., 1992a,b, 1996; Otero-Patin˜o et al., 1998). Remote locations and difficult geographic conditions make it difficult to carry victims to the hospitals, thus, resulting in delays in medical treatment of most cases. The present study was performed with the aim of producing an inventory of the plants used by traditional healers to treat snakebites in the northwest region of Colombia, and to document the experience of these healers as regards methods of preparation, administration, dosage and results of treatment.
2. Materials and methods
2.1. Study area Rural communities located near towns in the Departments of Antioquia and Choco´ were selected as study sites due to the prevalence of traditional medicine practices in the treatment of
Fig. 1. Pitvipers that inflict 90% of snakebites in Antioquia and Choco´. (A) B. atrox asper; (B) P. nasutum; (C) B. punctatus; (D) B. schlegelii.
R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504
495
Fig. 2. Study area. Towns and rural communities visited (O). Bojaya´ (Bellavista, La Loma, La Vuelta, Pogue), Vigı´a del Fuerte (Murrı´, Vuelta Cortada), Unguı´a (Arquı´a, Raicero, Gilgal, Titumate, Balboa) and Riosucio (Los Katios National Park) in the Atrato River valley. Nuquı´ (Jurubida´, Puerto Indio) and Bahı´a Solano (Utrı´a National Park, El Valle, Boroboro, Pozamansa) in the Pacific coast.
snakebites (Otero et al., 1992a). These communities include Bojaya´ (Bellavista, La Loma, La Vuelta, Pogue), Vigı´a del Fuerte (Murrı´, Vuelta Cortada), Unguı´a (Arquı´a, Raicero, Gilgal, Titumate, Balboa) and Riosucio (Los Katı´os National Park) in the Atrato river valley, and Nuquı´ (Jurubida´, Puerto Indio) and Bahı´a Solano (Utrı´a National Park, El Valle, Boroboro, Pozamansa) in the Pacific coast (Fig. 2).
2.2. Inter6iew and plants collection Interviews were held with traditional healers in all sites selected during two visits of 6 days duration each in every place, and data were recorded. These data include, age of healer, years of experience in the treatment of viper bites and number of patients treated during that time, plants and part used, methods of extract preparation, dose, route
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496
of administration, duration of treatment and occurrence of deaths. All healers recognized through pictures the venomous snake species that inhabit the study area. They also know that viper bites induce local signs such as swelling, hemorrhage, necrosis and life-threatening systemic signs, such as hemorrhage at a distance from the bite site, shock, and renal failure. Together with the healers, plants were collected and photographed, and brought to Medellin for identification at the Herbarium of the University of Antioquia (HUA). A set of voucher specimens are in deposit at this herbarium.
venomation (swelling and local hemorrhage). A total of 454 patients had been treated, 20 of them (4.4%) died (Table 1). Most cases were bites by B. atrox asper, based on memory recollection of healers. Ten patients with severe envenomation and complications (hemorrhage, anuria, extensive necrosis or unconsciousness) were reported and were delivered to local hospitals in nearby towns, but the final outcome was not known. Two of the shamans said that they also had experience in treating Bothrops bites in cattle and horses.
3.1. Ethnobotanical treatment 2.3. Statistical analysis A database was prepared with the information provided by shamans and healers and the data were analyzed using the computer program STATGRAPHICS 5.0 (STSC, Inc., Rockville, MD).
3. Results Twenty shamans and traditional healers were interviewed between August, 1996 and November, 1998. These individuals belong to nine black and three indigenous rural communities (Embera and Cuna ethnic groups) in the study area. The majority of these healers had extensive experience (5 – 60 years) in treatment of Bothrops and Porthidium bites. Only two of the healers had treated a few patients bitten by Bothriechis schlegelii and they agree that this arboreal pitviper induces mild enTable 1 Statistical data obtained from 20 traditional healers interviewed in Antioquia and Choco´ with experience in treating Bothrops, Porthidium and Bothriechis snakebites
Age (years) Years of experience Number of plant species used by everyone Patients treated (n =454) Mortality, n =20 (4.4%) a
The mode was zero.
Range
Mean 9 S.D.
31–90 5–60 5–40
579 16 26 9 16 159 9
3–60 0–6
239 19 1 9 1.8a
Based on field interviews described, 101 species of plants were identified as having been used to treat snakebites. A list of 77 of these plants, collected in the presence of the healers, is presented in Table 2. Data on common name, part used, form of use, route of administration, and voucher herbarium specimens are given. Sixty of the plants (singly or in combination) are used in the form of drinks prepared by infusion, decoction or maceration, in each case, a handful of each plant is prepared in 2 l of water. Extracts are administered one-half-a-cup three or four times a day in cases of mild and moderate envenomations, at 1-h intervals during the first day, and three to four times a day in subsequent days, in cases of severe envenomation. Seventyeight plants are used as external baths on the affected extremity, and as extracts prepared in a similar manner and administered at the same intervals as described above. The technique of application is to moisten a cloth or a hen feather with the extract and rub it on the extremity from the upper to the lower part of the edema, in order ‘to avoid venom diffusion through the blood stream’. Eleven plants are used in the form of steam application, three times a day. When a patient has local necrosis on the skin and soft tissues, the healers prepare poultices made with extracts of plants, including a handful of chopped stem bark, and crushed roots or leaves (e.g. Nicotiana tabacum), and mixing them with a small amount of ordinary salt and heated brown sugar (two
Decoction
Decoction Decoction or ethanolic extract
LF, BR, ST RH LF, BR, ST WP RH LF, BR RH WP RT WP WP LF, BR, ST
Copita de oro Huevo berraco Terciopelo Matapuerco, aviol tumat (in Cuna) Palo de la X, papayuelo, naipe kualu (in Cuna) Anturio 3 dedos, panue (in Cuna) Pos, tusilla Zaragoza, capitana, gallito, yansaguitup (in Cuna) Guaco negro Don˜a Juana Matapescado, ugla (in Cuna) Venadillo no amargo
Araceae/Philodendron tripartitum (Jacq.) Schott (RF6460) Araceae/R. oblongata Poeppig (RF 6439) Aristolochiaceae/Aristolochia grandiflora Sw. (RF 6340) Aristolochiaceae/Aristolochia pilosa H. B. K. (RF 6454) Asteraceae/Adenostemma la6enia (L.) Ktze. (RF 6247) Asteraceae/C. sil6estre (Aublet) Baill. (RF 6447) Asteraceae/E. 6alerianaefolia (Wolf.) DC. (RF 6432) Asteraceae/M. guaco H.B.K. (RF 6412) Asteraceae/N. lobata (L.) K. and R. (RF 6406) Bignoniaceae/Crescentia cujete L. (RF 6739) Bignoniaceae/Macfadyena unguiscati (L.) A. Gentry (RF 6734) Bignoniaceae/Tabebuia rosea (Bertold.) DC. (RF 6458) Bixaceae/Bixa orellana L. (RF 6485)
Decoction
WP
Pega–pega
Decoction or maceration
Decoction or ethanolic extracts Decoction
LF, BR, ST UF WP
SB LF, BR
Contragavilana, Venadillo amargo Totumo Lagartija, pega–pega.
Roble, guayaca´n rosado, guagul (in Cuna) Achiote rojo, misal kinip (in Cuna)
Decoction
Decoction
Decoction or maceration
Guaco morado, nuskı´du (in Cuna) WP
Decoction or maceration
Decoction
Decoction
Decoction
Decoction
Decoction and maceration
Decoction
Decoction
Decoction
Decoction
WP
Pitipiticorre´ (in Embera)
Form of use
Acanthaceae/J. secunda Vahl (RF 6408) Amaranthaceae/A. aspera L. (RF 6343) Apocynaceae/Allamanda cathartica L. (RF 6737) Araceae/Alocasia cucullata (Lour.) G. Don (RF 6239) Araceae/A. marmoratum Sod. (RF 6438) Araceae/D. longispatha Engl. and Krause (RF 6450) Araceae/D. croatii Zhu. (RF 6245)
Part usedb
Common Name
Family/species (voucher specimen)a
Table 2 Plants used to treat snakebites in northwestern Colombia
As drinks and external baths
As drinks and external baths
External baths
Drinks
As drinks, external baths and poultices As drinks and external baths
As drinks and external baths
As external baths, steams and poultices As drinks and external baths
As drinks and external baths
As drinks and external baths
Poultices
As drinks, external baths and poultices External baths
As drinks and external baths
As external baths and poultices
As external baths and poultices
External baths
As drinks and poultices
As drinks and external baths
Route of administration
R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504 497
Common Name
Decoction Juice and macerated
Decoction
LF, BR, ST ST
LF, BR, ST Decoction
Poultices External baths
Decoction or maceration Decoction Decoction
Decoction or maceration
As drinks, external baths and poultices As drinks and external baths
Decoction
BR, ST
As drinks and external baths
Decoction or maceration
As drinks and external baths
As drinks, steams and poultices
As drinks and external baths
Decoction
Infusion
As external baths and poultices
BR, ST
BR
Decoction
BR, ST, RF Decoction BR
As drinks, external baths and poultices
As drinks, external baths and poultices External baths
As external baths and poultices
Decoction
WP
As drinks and external baths
Decoction or maceration
Decoction or ethanolic extract
SB
As external baths and poultices
Decoction or maceration
Decoction or maceration
LF, ST
As external baths and steams
Route of administration
As drinks, external baths and poultices As drinks, external baths and poultices As drinks, external baths and poultices As drinks and external baths
Decoction
Form of use
LF, BR, ST
Part usedb
Cucurbitaceae/Fe6illea cordifolia L. Calabacita, mantecona, aviata (in WP (RF 6341) Embera), uier kuadup (in Cuna) Cucurbitaceae/M. charantia L. (RF Balsamina, fruto de la culebra. LF, 6407) Euphorbiaceae/P. acuminatus Vahl Chirrinchao LF, (RF 6435) Fabaceae/D. adscendens (Sw.) DC. Amor seco, prende amor, pega–pega WP (RF 6431) Gentianaceae/I. alata (Aubl.) Maas Yerba de Ada´n LF, subsp. alata. (RF 6747) Gesneriaceae/B. sanguinea Pers. (RF Sangre de Cristo WP 6487) Gesneriaceae/C. pulcherrima Morton Sanguinaria, guaquito, WP (RF 6417) Kiduasapopoa (in Embera) Gesneriaceae/E. dianthiflora Moore Amargosa, escama de la verrugosa WP and Wilson (RF 6461) Haemodoraceae/Xiphidium caeruleum Manito de Dios, cola de babilla WP Aublet (RF 6731) Heliconiaceae/H. curtispatha Petersen Platanillo rojo, nakutagor (in Cuna) RH (RF 6486) Hymenophyllaceae/Trichomanes Helecho loro, naipe uki (in Cuna) WP elegans L.C.Rich (RF 6744) Lamiaceae/Ocimum basilicum (L.) Albahaca blanca LF, Willd. (RF 6730) Lamiaceae/H. capitata Jacquin (RF Trampolı´n, tres pelotas montan˜eras LF, 6732)
Boraginaceae/T. cuspidata H. B. K. Tuinakau¨n (in Embera) (RF 6420) Cactaceae/P. bleo (H.B.K.) DC. (RO Chupamelo´n 4) Caesalpiniaceae/B. rosademonte Berg. Florisanto, ariza´, tuksal (in Cuna) (RF 6455) Caesalpiniaceae/S. dariensis (Br. And Ambuima´fono (in Embera) R.) I. and B. (RF 6418) Convolvulaceae/I. cairica (L.) Sweet. Bejuco estrellita (RF 6738) Costaceae/C. guanaiensis Rusby. var. Can˜agria macrostrobilus (K.Sch.) Maas (RF 6251) Costaceae/C. lasius Loes. (RF 6244) Can˜agria menuda
Family/species (voucher specimen)a
Table 2 (Continued)
498 R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504
Common Name
Loganiaceae/Strychnos xinguensis Solita Krukoff (RF 6729) Loranthaceae/Struthanthus orbicularis Golondrino, matapalo (H. B. K.) Blume (RF 6422) Malvaceae/S. acuta Burm. f. (RF Escobabosa, kuala (in Cuna) 6238) Menispermaceae/O. tenacissima Diels Morna´guitup (in Cuna) (RF 6445) Monimiaceae/S. thecaphora (P. and Limoncillo de monte, costen˜o. E.) A. DC. (RF 6419) Moraceae/C. elastica Sesse´ (RF Caucho hembra 6443) Moraceae/F. nymphaeifolia Miller Matapalo, mamartup (in Cuna) (RF 6448) Passifloraceae/P. quadrangularis L. Badea, tabijo (in Embera) (RF 6415) Phytolaccaceae/Peti6eria alliacea L. Anamu´ (RF 6241) Piperaceae/P. elsana Trel. And Yun. Kiduaborogoa (in Embera) (RF 6409) Piperaceae/P. arboreum Aublet (RF Kansarimia (in Embera) 6413) Piperaceae/P. auritum H.B.K. (RF Santa Marı´a de anı´s. 6426) Piperaceae/Piper coruscans H.B.K. Cordoncillo (RF 6240) Piperaceae/Piper hispidum Sw. (RF Cordoncillo 6433) Piperaceae/P. longi6illosum T. and Y. Yerba de la verrugosa (RF 6484) Piperaceae/Piper marginatum Jacq. Deshinchadora, cordoncillo, rollera (RF 6342) (in Cuna) Piperaceae/Piper multipliner6ium C. Cordoncillo DC. (RF 6434) Piperaceae/Piper peltatum L. Santa Marı´a boba [(= Pothomorphe peltata (L.) Miquel)] RF (6441) Piperaceae/P. pulchrum C. DC. (RF Arbol de la verrugosa 6430) Piperaceae/Piper reticulatum L. (RF Cordoncillo, deshinchadora, rollera 6428) (in Cuna)
Family/species (voucher specimen)a
Table 2 (Continued)
Decoction Decoction Decoction or maceration Decoction Decoction Decoction or maceration Decoction Maceration Decoction Decoction or maceration Decoction or infusion Decoction or maceration Decoction or maceration Decoction or maceration Decoction or maceration Decoction or maceration
Decoction or maceration Decoction or maceration
LF, BR WP WP LF, BR, ST LF, BR, ST LF, BR, ST LF, BR LF, BR WP LF, BR LF, BR, ST LF, BR, ST LF, BR, ST WP LF, BR, ST LF, BR, ST LF, BR, ST
LF, BR, ST LF, BR, ST
Form of use Decoction or maceration or ethanolic extract Decoction
ST
Part usedb
As drinks, external baths and poultices As drinks, external baths and poultices
As drinks, external baths and poultices As drinks, external baths and poultices As drinks, external baths and poultices As external baths, steams and poultices As drinks, external baths and poultices As drinks, external baths and poultices As drinks, external baths and poultices
As external baths and poultices
As external baths, steams and poultices External baths
External baths
As drinks and external baths
As drinks, external baths and poultices As drinks and external baths
As drinks and external baths
As drinks and external baths
External baths
External baths
Route of administration
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Decoction or maceration Juice
WP LF, BR, ST LF, BR, ST RF
Bichikirami (in Embera) Palito x, chamizo, dadia´to (in Embera) Boca de negro, sombrerito del diablo, ajı´ del diablo Limo´n pajarito
WP WP, MR WP, CS RF LF, BR, ST
LF, BR, ST, FR Decoction or maceration WP LF, BR, ST RH
Yerba verde del carpintero Cruceto, udupungit (in Cuna) Cedro´n Ajı´ pajarito Chucho fruteador Sauco amargo Yerba del Comeje´n Ochorro´neta (in Embera) Matandrea
Decoction or ethanolic extract
Decoction
Decoction or ethanolic extract
Decoction or maceration
Maceration
Decoction
Decoction or ethanolic extract
Decoction or ethanolic extract
Decoction
WP
Escobilla, escoba menudita
Decoction or maceration
WP
Yerba del pollo
Decoction
Decoction
As drinks and external baths
As drinks, external baths, steams and poultices As external baths and poultices
As drinks and external baths
As drinks and external baths
Drinks
As drinks and external baths
As drinks and external baths
As drinks, external baths and poultices As drinks and poultices
As drinks and external baths. Some shamans use crushed roots in poultices Poultices
As drinks, external baths and poultices As drinks and external baths
External baths
As drinks and external baths
As external baths and poultices
Route of administration
b
Voucher specimen: RF, Ramiro Fonnegra and other collectors; RO, Rafael Otero and other collectors. Part used: BR, branches; CS, crushed seeds; FR, fruits; LF, leaves; MR, mainly roots; RF, ripe fruits; RH, rhizomes; RT, roots; SB, stem bark; ST, stem; UF, unripe fruits; WP, the whole plant.
a
Scrophulariaceae/L. diffusa (L.) Wettst (RF 6488) Scrophulariaceae/S. dulcis L. (RF 6242) Selaginellaceae/S. articulata (Kunze) Spring. (RF 6457) Simaroubaceae/Q. amara L. (RF 6442) Simaroubaceae/S. cedron Planch. (RF 6449) Solanaceae/C. frutescens L. (RF 6345) Solanaceae/S. allophyllum (Miers.) Standl. (RF 6437) Solanaceae/S. nudum Dunal (RF 6429) Triuridaceae/S. purpurea Benth. (RF 6427) Verbenaceae/A. panamensis Mold. (RF 6411) Zingiberaceae/R. alpinia (Rottb.) Maas (RF 6456)
Decoction or maceration
LF, BR, ST
Costen˜o, hoja mano
Decoction
LF, BR, ST
Tortugo
Form of use
Piperaceae/Piper cf. spoliatum Yun. (RF 6462) Piperaceae/Piper tricuspe DC. (RF 6237) Polypodiaceae/P. percussa (Cav.) Hook and Grev. (RF 6410) Rubiaceae/Gonzalagunia panamensis (Cav.) Schumm. (RF 6405) Rubiaceae/Psychotria poeppigiana Muell-ARg. (RF 6246) Rutaceae/C. limon (L.) Burm.f. (RF 6736)
Part usedb
Common Name
Family/species (voucher specimen)a
Table 2 (Continued)
500 R. Otero et al. / Journal of Ethnopharmacology 71 (2000) 493–504
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spoonfuls). The mixture is then applied by wrapping the extremity with a long leaf (for example, an aroid leaf) or a piece of cloth. In mild or moderate envenomations, the healers generally use a mixture of three different plants in preparing the drinks and for external baths, while in severe cases they mix from five to 12 different plants. Some plants are used for a specific function, for example, as an anti-inflammatory (e.g. Piper sp. and Aristolochia sp.), as an antihemorrhagic (e.g. Gesneriaceae, Asteraceae, Rubiaceae, Acanthaceae, Loganiaceae) or as a cicatrizant (e.g. Dracontium croatii ). Seven shamans and traditional healers also use 30 – 38% (v/v) ethanolic extracts of plants. Every year, during the week before Easter, the healers prepare a mixture of different plants (up to 40) which is added to a glass bottle containing 1.0 – 1.5 l of cane firewater liquor (‘aguardiente de can˜a’). When a patient arrives at a shaman’s home, he/she initially receives one-half-a-cup of this drink; then, while the shaman goes to collect fresh plants in the forest, which will be used to prepare the medication to complete the treatment. Other traditional methods used for treating snakebites in black communities are: prayers, mouth suction, incisions, and tourniquets; an absorbent material known as ‘black stone’ may also be placed on the bite marks. Some healers treat patients with the assumption that ‘one poison neutralizes another ’. Thus, they sometimes use, as the complete treatment, drinks of lemon juice (one-half-a-cup) mixed with toxic chemical products, such as the powder of the insecticide mercurious chloride (Calomel®, 0.4 g) or three drops of antiseptic cresols (Veterina®) or fuel oil (one tea spoon), or external baths by rubbing the affected extremity with the juice of five lemons mixed with ammonia (five drops) or a small amount of potassium permanganate. Treatment is generally performed for 1 – 3 days, when the patient reacts positively. If the patient has local necrosis, poultices are continued until healing is accomplished. Eight of the 20 shamans complete the treatment by giving the patient a ritual bath in the river, while another eight administering a laxative. If the patient does not feel any dizziness, he is assumed to be cured; this is what shamans and healers believe.
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3.2. Plant collection The 77 species of plants in Table 2 belong to 41 families, with the highest number of species distributed in the following families: Piperaceae (13); Araceae (6); Asteraceae (5); Gesneriaceae (3); Solanaceae (3); and Bignoniaceae (3).
4. Discussion and conclusions Many plants have been reported worldwide to be used by traditional healers for the treatment of snakebites. Mors (1991), Martz (1992) reported 578 species belonging to 94 families as having been used to treat snakebites, with the highest number of species recorded for the Asteraceae (9%), Leguminosae (7.8%) and Euphorbiaceae (4.5%). Houghton and Osibogun (1993) reported 781 species in 121 families, with the highest number of species recorded for the Leguminosae (60), Compositae (58) and Euphorbiaceae (42). Black and indigenous people inhabiting the region of this study have been using medicinal plants since preconquest epoch, a knowledge they inherited by oral tradition from generation to generation. In addition to native plants, species from Europe were introduced, in the same way as in Brazil and Mexico (Reyes and Jime´nez, 1995; Alvares-Pereira et al., 1996). During the eighteenth and nineteenth centuries, many plants were reputed used for the treatment of snakebites, such as species of Aristolochiaceae and Piperaceae, as well as Mikania guaco, Achyranthes aspera, Desmodium adscendens, Strychnos sp., Capsicum frutescens, Citrus limon and N. tabacum (TadeoLozano, 1808; Garcı´a, 1896). Other plants used to treat snakebites had also been reported from Colombia during the present century, such as Simaba cedron, Costus guanaiensis, Renealmia alpinia, Brownea rosademonte, Sida acuta, Scoparia dulcis and others (Florez, 1951; Abadı´a, 1977; Fonnegra and Rolda´n, 1994). After reviewing existing databases (Duke, 1998; Beckstrom-Sternberg et al., 1994) and the available literature on this topic, we are adding to the checklist 34 additional species, as follows: Aegiphila panamensis, Anthurium marmoratum,
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Fig. 3. Severe envenomation caused by B. atrox asper.
Castilla elastica, Clibadium sil6estre, Costus lasius, Dieffenbachia longispatha, D. croatii, Erechtites 6alerianaefolia, Ficus nymphaeifolia, Heliconia curtispatha, Hyptis capitata, Ipomoea cairica, Irlbachia alata, Justicia secunda, Lindernia diffusa, Odontocarya tenacissima, Peperomia elsana, Pereskia bleo, Phyllanthus acuminatus, Piper arboreum, Piper longi6illosum, Piper pulchrum, Piper spoliatum, Pleopeltis percussa, Rhodospatha oblongata, Sciaphila purpurea, Selaginella articulata, Senna dariensis, Siparuna thecaphora, Solanum allophyllum, Solanum nudum, Struthantus orbicularis, Tournefortia cuspidata and Thrichomanes elegans. Furthermore, we report in this paper 13 new plants that are used only by the indigenous communities of northwestern Colombia: A. panamensis, C. elastica, C. sil6estre, F. nymphaeifolia, J. secunda, O. tenacissima, Passiflora quadrangularis, P. elsana, P. arboreum, P. percussa, S. dariensis, S. thecaphora and T. cuspidata. Edema, local and systemic hemorrhage, blistering, myonecrosis and the alteration of blood coagulation are conspicuous effects of Bothrops envenomations (Fig. 3). Lethality can be the result of these effects as well as the overlying infection and renal failure (Rosenfeld, 1971; Otero et al.,
1992a, 1996; Otero-Patin˜o et al., 1998). Traditional healer’s treatment for snakebites is usually intended to improve the local damage (local pain, edema, necrosis) and to stop the venom-induced hemorrhage (Joly et al., 1987; Houghton and Osibogun, 1993). A combination of three or more plants is expected to produce synergism in their action. Some shamans called several plants as ‘brother plants’ (e.g. C. elastica and F. nymphaeifolia), which they use in an uneven number, with a belief that one plant would resolve the possible antagonism between pairs of plants (e.g. Quassia amara, O. tenacissima, and S. cedron; Neurolaena lobata, Momordica charantia and C. guanaiensis). Sometimes, morphological analogies (Doctrine of Signatures principle) is closely followed. For example, they use roots, stems or leaves from snake-shaped plants (such as vines or rhizomes of D. croatii ), leaves with a texture like a viper’s skin scales (such as P. longi6illosum or P. pulchrum), and plants with red-spotted or reddish leaves, flowers or fruits for treating hemorrhage (such as Columnea pulcherrima and Besleria sanguinea). Moreover, all shamans are convinced that the most effective plants are those having a bitter taste (e.g. Episcia dianthiflora or Piper auritum).
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Although traditional healers or shamans are sometimes reluctant to accept failures in the treatment of snakebites, they reported 4.4% mortality during the interviews. This rate is not significantly different to that (5.0%) of previous studies performed in hospitals of the region, corresponding to patients who were initially treated by shamans, then by serotherapy in a hospital, but too late resulting in death as a consequence of cerebral hemorrhage or renal failure (Otero et al., 1992a). Because an increase of knowledge of medicinal plants can contribute to the elucidation of the rational basis of their use, and is useful in the development of low-cost phytotherapeuticals (Elisabetsky, 1991), further work that would demonstrate the presence of bioactivity and elucidate the structure of the active principles of extracts of plants described here against snake venoms, will be of great interest.
Acknowledgements We thank the staff of the hospitals, local governmental authorities, the communities in the region of study, the Direccio´n Seccional de Salud del Choco´, Ministerio del Medio Ambiente and the personnel of the Utrı´a and Katı´os National Parks for their cooperation. To the traditional healers Emiliano Palacio, Emiliano Palacio Jr., Basiliso Alvarez and Alberto Chaverra from Bojaya´, Dora Blando´n, Zoilo Sa´nchez and Rosaura Gutie´rrez from Vigı´a del Fuerte, Arnulfo Arango, Leandro Palomeque and Juan de Dios Rojas from Nuquı´, Menedesmo Valoy, Francisco Valoy, Gabriel Conde and Isidro Alvarado from Bahı´a Solano, Anı´bal Padilla, Hilario Ramı´rez, Angel Padilla, Julio Galvis, Darı´o Ma´rquez and Angel Salazar from Unguı´a we also express our thanks. Thanks go to Elizabeth Cadavid and Janeth Garcı´a for preparing the manuscript, and Mr Alex Parra for reviewing the English language of the manuscript. This project was supported by funds from the Instituto Colombiano para el Desarrollo de la Ciencia y la Tecnologı´a Francisco Jose´ de Caldas (Colciencias) and from the Universidad de Antioquia.
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