Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature review

CHNAES-00676; No of Pages 13 Acta Ecologica Sinica xxx (2020) xxx

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Acta Ecologica Sinica journal homepage: www.elsevier.com/locate/chnaes

Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature review Hammad Ahmad Jan a,⁎, Samin Jan a, Rainer W. Bussmann b, Sher Wali a, Francesca Sisto c, Latif Ahmad d a

Department of Botany, Islamia College Peshawar, Pakistan Department of Ethnobotany, Institute of Botany, Ilia State University, Tbilisi, Georgia Department of Biomedical, Surgery and Dental Sciences University of Milan, Via C. Pascal 36, 20133 Milano, Italy d Department of Botany, Shaheed Benazir Bhutto University, Sheringal, Dir Upper, Pakistan b c

a r t i c l e

i n f o

Article history: Received 22 July 2019 Received in revised form 15 September 2019 Accepted 19 December 2019 Available online xxxx Keywords: Medicinal plants Research Future Limitations Pakistan

a b s t r a c t This review article is an effort to analyze the status of medicinal plants research in Pakistan. According to an estimate, about 6000 plant species are present in Pakistan of which about 700 have medicinal importance. The majority of the local population in Pakistan depends on therapeutic plants. Various Pakistani institutes are conducting research on medical plants. Pakistan is at the center of the international herbal market. The Pakistan position in the international herbal market in import is 9th and in export is 10th. In 2002 the market value of therapeutic and aromatic plants sold globally was estimated at 62 billion US$, and 2018 it had increased to 131.4 billion. This means medicinal plants are the income source for people, and if the medicinal flora is not managed properly, this may result in habitat destruction, as well as species extinction. For ex-situ conservation of medicinal plants, the Higher Education Commission (HEC) of Pakistan is working with universities to establish botanical gardens. The government also needs to take steps to enforce stricter laws for conservation, to find sustainable ways to harvest medicinal plants from the wild, to educate native collectors in suitable collection methods, to train the local community how to grow therapeutic herbs, and to eliminate the middle-men from the trading chain. © 2019 Ecological Society of China. Published by Elsevier B.V. All rights reserved.

Contents 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

15. 16.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pakistan healthcare system situation . . . . . . . . . . . . . . . . . . . . . Therapeutic plants as research aspects . . . . . . . . . . . . . . . . . . . . Pharmacological and chemical analysis . . . . . . . . . . . . . . . . . . . . Therapeutic plants antimicrobial activities. . . . . . . . . . . . . . . . . . . 6.1. Benefits and challenges to plants used as antimicrobial . . . . . . . . . Ex situ conservation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . The wealth of the Therapeutic Flora of Pakistan . . . . . . . . . . . . . . . . Herbal medicines increasing global demands and present scenario in Pakistan . . Economic perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . Recent development in phytomedicines . . . . . . . . . . . . . . . . . . . Phyto-medicines and future challenges . . . . . . . . . . . . . . . . . . . Extent and causes of threats to medicinal plants in Pakistan . . . . . . . . . . Threats causes to medicinal plants survival. . . . . . . . . . . . . . . . . . 14.1. Deforestation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.2. Dependence of local population and Afghan refugees on medicinal plants Ethnic healthcare and plant extinction . . . . . . . . . . . . . . . . . . . . Medicinal plants collection chain in Pakistan . . . . . . . . . . . . . . . . .

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⁎ Corresponding author. E-mail address: [email protected] (H.A. Jan).

https://doi.org/10.1016/j.chnaes.2019.12.005 1872-2032/© 2019 Ecological Society of China. Published by Elsevier B.V. All rights reserved.

Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005

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H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx

17. 18.

Policy issues in relation to promoting large scale cultivation and conservation . . . WWF conservation and livelihood improvement collaborative project (a case study) 18.1. Ayubia national park. . . . . . . . . . . . . . . . . . . . . . . . . . 19. Traditional/complementary and alternative medicines regulation . . . . . . . . . 19.1. Tibb national council (TNC) . . . . . . . . . . . . . . . . . . . . . . 19.2. Homoeopathy national council (HNC) . . . . . . . . . . . . . . . . . . 20. Complementary/traditional and alternative medicines research and development . 21. Rights of intellectual property and indigenous knowledge protection . . . . . . . 22. Key developing issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. Priorities of conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. Capacity building priorities in ethno-botany . . . . . . . . . . . . . . . . . . 25. The system's prospects and limitations . . . . . . . . . . . . . . . . . . . . . 25.1. Prospects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26. Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Consent for publication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acknowledgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1. Introduction Pakistan is located on East Longitude 60°55′ to 75°30′ and on North Latitude 23°45′ to 36°50′ and occupies an area of 80,943 km2. Pakistan has a different climate and bio-diversity due to the large altitudinal gradient ranging from sea-level to 8.611 m. Almost six thousand plant species have been reported [1], of which about 600–700 are known for their medicinal use. Pakistan's hotspot flora is distributed in thirteen Natural Regions i.e., Alpine pastures to Mangroves, where the endangered flora is N10% [2,3]. Phytogeographically Pakistan is divided into four regions: (i) Indian region (6%); (ii) Saharo-Sindian region (9.5%); (iii) Sino-Himalayan region (10%); and (iv) Irano-Turanian region (45% of species) (Fig. 1). The diversity of plants is lowest in the Saharo-Sindian region that covers the largest area of the country [1]. In recent years, interest to use traditional remedies has been increasing globally. The WHO (World Health Organization) supports the alternative and traditional medicines in preventive health care, particularly in countries of the third world; furthermore, it motivates allied

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countries to support ethnic remedies and to make policies with special guidelines [4]. In Pakistan, the medicinal plants' research mainly focuses on the documentation of the medicinal flora and its uses. The indigenous population has centuries-old knowledge of traditional uses of the local flora, inherited from their ancestors [5]. The Unani and Ayurvedic systems have been increasing therapeutic qualities, but the valuable medicinal plants' knowledge of ethnic groups is threatened to be lost [6]. In Pakistan, there are about 130.000 homeopaths, 3.584 Hakems and 455 Vaids registered. Approximately 457 Tibbi-e-Unani dispensaries and clinics are providing healthcare facilities. According to one estimate, about 300–350 Tibb-e-Unani/Herbal medicines producing industries, and 300 homeopathic drugs producing companies are present [7]. The exploitation of medicinal flora for commercial purposes results in species endangerment. The medicinal flora of an area is the imperative source of income for the local population and also for herbal traders, but in Pakistan, there is no proper farming of medicinal herbs. The main focus of this review paper is to describe the present status of medicinal plants in Pakistan, practices of cultivation, protection, and justified

Fig. 1. Pakistan's Floristic Regions (Medicinal plants research in Pakistan Zabta K. Shinwari).

Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005

H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx

utilization of medicinal flora for income generation. This review is meant to be a baseline for researchers, research institutions, and conservation organization in either planning or starting research activities associated medicinal plants of Pakistan. 2. Methods The literature for this review paper was collected from the papers published since 1990 in both non-indexed and indexed journals through online bibliographic databases, such as PubMed, Scopus, Google, Google Scholar, Web of Science, ISI Web of Knowledge and Science Direct Navigator and also some library sources. During the data collection through databases, different words were used as indicated below: review of medicinal plants of Pakistan; review on the scope of medicinal plants of Pakistan, review on the history of medicinal plants of Pakistan, review on the scope of medicinal plants research in Pakistan, review on the current and past status of research of medicinal plants in Pakistan, review on the phytochemical study of the medicinal plants of Pakistan, review on the limitations of medicinal plants research in Pakistan and review on the advantages, complementary and alternative medicinal plants of Pakistan and disadvantages of medicinal plants research in Pakistan etc.. Only the articles containing data on the scope, prospects, limitations, current research status of complementary and alternative medicinal plants of Pakistan, were selected for this review. The Plant database “The Plant List” has been used for the taxonomic corrections of all the documented plant species [8]. 3. Pakistan healthcare system situation About 60.78% population of Pakistan is living in rural areas [9]. Illiteracy, poverty, low status of women, poor quality of drinking water and sanitation has a profound effect on their health [10]. Inadequate awareness of health and diseases, health service perceptions and barriers within the society are the main limitations [11,12]. In Pakistan, the healthcare system has two chief domains: private and public. The public domain is well organized and regulated and primarily based on allopathic healthcare. This system is however underutilized because of some flaws comprising inadequate attention of the promotion of health, unnecessary management centralization, political interference, underdeveloped human resource, absence of amalgamation and polices for public health [13,14]. The private domain has a few recognized hospitals or health centers and a number of unrecognized hospitals, medical practitioner, homeopathists, hakims, Unani (Grecoarab) herbalists [15]. The population largely prefers alternative medicines, because they are linked to spiritual therapists, hakims, and homeopathists. They are the primary choice for the cure of diseases like epilepsy, infertility, depression, psychosomatic troubles, etc. [16]. People consult them because of nearness, affordability, family pressure and the community's strong opinion [17]. 4. Therapeutic plants as research aspects In addition, to investigate active and new chemical constituents, researchers are also working to elucidate novel aspects of therapeutic plants. Table 1 shows Pakistan's prominent educational and investigation institutions working on the therapeutic flora of Pakistan [18,19]. 5. Pharmacological and chemical analysis Many studies have addressed the pharmacological and chemical properties of therapeutic plants: Khattak et al., [20] conducted antipyretic activity on rabbits of Viola odorata L., Melia azadirachta L., Fumaria parviflora Lam., Artemisia abisnthium Y.R.Ling & S.Y.Zhao), Butea frondosa Roxb., Berberis lycium Royle and Sisymbrium irio L. in which the former four plants showed antipyretic activity while the latter did not show any profound results; Gilani et al., [21] investigated the

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hypotensive and spasmolytic activities of Moringa oleifera Lam.; Gilani et al., [22] carried out experiments on Fumaria indica (Hausskn.) to study its effectiveness in constipation and diarrhea; Mahmood et al., [23] studied the macro and microscopic features and performed analysis of powdered drug of Acacia modesta Wall., Acacia nilotica (L.) Delile, Berberis lycium Royle and Zanthoxylum alatum D. C. Prod.; Gilani et al., [24] carried out phytochemical, pharmacological and ethnobotanical studies of Rhazya stricta Decne; Ahmad et al., [25] has carried out experiments to check the effectiveness of leaves extracts of Pistacia integerrima J. L. Stewart ex Brandis against hyperuricemia and gout; Fazal et al., [26] has studied 11 medicinal plants for their pharmacological activities; Hussain et al., [27] has carried out a study on Lepidium sativum L., Nerium oleander L., Ranunculus repens L., Tecoma stans and Urtica dioica L. to study their medicinal effectiveness; Khan et al., [28] carried out a pharmacological study of Acorus calamus L., Artemisia annua L., Cupressus sempervirens L., Chenopodium foliosum Asch., Euphorbia helioscopia L., Lepidium sativum L., Nerium oleander L., Ranunculus repens L., Tecoma stans L. Juss. ex Kunth and Urtica dioica L.; Shah et al., [29] has done the pharmacological study on the blue and white flowering Silybum marianum; Javed et al., [30] carried out a study to check the nutritional, phytochemical potential and pharmacological evaluation of Nigella sativa L. (Kalonji) and Trachyspermum Ammi (L.) Sprague. (Ajwain); Hussain et al., [31] performed a pharmacological study on Thymus linearis Benth and Thymus serpyllum L.; Wadood et al., [32] conducted a pharmacological study of Acacia nilotica (L.) Delile, Psidium guajava L., Luffa cylindrical (L.) Roxb., Morus alba L., Morus nigra L., Momordica charantia L., Fagonia cretica L., Punica granatum L., Ficus palmate Forssk. and Prunus persica (L.) Batsch; Hashim et al., [33] did experiments on Tribulus terrestris L. to study its chemical and pharmacological importance; Atta et al., [34] studied five selected vegetable plants to know their chemistry and pharmacognosy. Pharmaceutical research has tried to develop alternative medicines based on plants, assuming they would have fewer side-effects, low prices, easy availability and excellent compatibility. But much of these efforts failed in clinical trials and standardization of these medicines. 6. Therapeutic plants antimicrobial activities Shinwari et al., [35] identified the existence of inhibitory constituents (ACE), hence providing a scientific justification of therapeutic plants and their indigenous uses. All of them indicated action against some species of bacteria (Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Salmonella typhimurium, and Staphylococcus aureus). Hussain et al., [27] studied phytochemistry and antimicrobial activities of five therapeutic plants (Lepidium sativum L., Nerium oleander L., Ranunculus repens L., Tecoma stans (L.) Juss. ex Kunth and Urtica dioica L.). All these plants showed antimicrobial activity against the six species (Bacillus subtilis, Escherichia coli, Proteus vulgaris, Pseudomonas aeruginosa, Salmonella typhimurium, and Staphylococcus aureus). Ali et al., [36] demonstrated the antimicrobial activity of 16 plants species of Fabaceae family, against various species of bacteria and fungi. Ashraf et al., [37] demonstrated the antimicrobial activity of Euphorbia royleana against the Aspergillus niger, Bacillus subtillis, Eschericha coli, Fusarium solani and Pasteurella multocida.. Rahman et al., [38] conducted a study of the leaves of Ajuga bracteosa Wall. ex Benth., Calotropis procera (Aiton) Dryand. and Zizyphus jujube Mill. against human pathogenic bacteria Bacillus cereus, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa and Salmonella typhi. All three plants gave positive results against the above bacterial species. Khan et al., [39] studied the antibacterial activity of Oxalis corniculata L. against four skin affecting bacterial strains. The plant showed to be active against all four strains. Habiba et al., [40] demonstrated the antimicrobial activity of 30 therapeutic plants species utilized by the indigenous people of the Himalaya against wounds, against.Streptococcus pyogenes, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans, and Aspergillus.

Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005

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H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx

Table 1 Pakistan's prominent educational and research institutions working on therapeutic flora of Pakistan. S/No.

Name of department

Organization name

Area of interest

Involved since

1 2 3 4 5 6 7 8 9

Dept. of Botany; Pharmacy; Chemistry and Pak. Forest Institute ICCS, HEJ Inst.; Botany Dept. Hamdard Laboratories Dept. of Botany and Biochemistry Qarshi Research Int. Dept. Plant Sciences and Chemistry Department of Biological and Biomedical Sciences National Agric. Res. Center Dept. of Botany and Chemistry

Peshawar University Karachi University Hamdard, Karachi Baluchistan University, Quetta Qarshi Industries (Pvt) Ltd. Quaid-i-Azam University Agha Khan University, Karachi Pak. Agric. Res. Council, Islamabad Kohat University of Sci. and Tech.

Documentation; analytical work Chemical analysis Herbal Medicine Documentation and Analysis Herbal Medicine; Bot. Garden Ethnobotanical studies and Chemical analysis Pharmacognosy Cultivation and Documentation Documentation; analytical work

1950's 1960's 1960's 1970's 1980's 1980's 1990's 1990's 2004

6.1. Benefits and challenges to plants used as antimicrobial Currently, there is no plant-based antimicrobial drug, available. i. The extracts of plants are often extremely complex chemically, as a single extract has hundreds of compounds. To isolate the desired compound requires much time, resources and plant material in bulk amount, and single compounds are often either toxic or have little efficacy. ii. Access to plant material sometimes may be difficult because the regulations about the collection of plant materials and their export and import are different in different countries. iii. Plant-based therapies work along synergetic pathways. In synergism, various plant compounds work together in a unit and scientific technology is yet not fully developed to understand this phenomenon.

the “Society of Oriental Medicine Studies” worked on Kampo (customary Japanese drugs). Currently, about ten thousand members are working on it, of which 80% are allopathic doctors [6]. The cultivation of therapeutic plants is now a global trend. Annually 50 thousand tons of therapeutic plants are produced in Russia 50% of which are cultivated. In Lucknow (India) therapeutic plant production in gardens amounts to US$ 1.4 million per annum. When there is an increase in demand, cultivation in large quantity becomes indispensable, e.g., every year three thousand kg of Glycerrhiza (Glycyrrhiza glabra L.) are imported by the European Union (EU). Similar, in 2000 in China the medicinal industry overall production was worth 233 billion yuan (US$ 28 billion). In the international herbal market, Traditional Chinese Medicines share has been expanded from 3% to 15% in 2010 [6]. Shinwari [6], also reported the trade value of 22 medicinal plant species from the US $229,687 in 1990 to US$ 1.90 million in 2002. Similarly, the export rose to the US $10.5 million in 2012.

7. Ex situ conservation 10. Economic perspectives For promoting the ex-situ conservation of medicinal plants, Pakistan's Higher Education Commission (HEC) has financially supported all universities of the public sector to establish botanical gardens. While this initiative was embraced by various universities of Pakistan, many obstacles are present in the establishment of these botanical gardens (Table 2). 8. The wealth of the Therapeutic Flora of Pakistan A few early reports on medicinal plants uses of Pakistan are available [41]. Shinwari et al., [42] published a “Pakistan's medicinal plants pictorial guide” about therapeutic flowering plants, including N500 species. Jan et al., [43] conducted a survey in Dir Kohistan and documented 34 medicinal plants species used to cure dysentery and diarrhea. In the Miandam of Swat Valley, Akhtar et al., [44] conducted a survey for the medicinal plants' documentation. During the survey, they have documented 106 medicinally important plants. Similarly, several valuable studies of such kind are conducted by numerous workers on medicinal plants in different parts of the country a few are given in Table 3. These ethnomedicinal studies have provided valuable data and baseline for future phytochemical studies, antimicrobial studies, and drugs discovery. 9. Herbal medicines increasing global demands and present scenario in Pakistan About 2500 plants are internationally traded [67]. The global efforts for the medicinal plants' species and the conservation of their environment are a relatively recent phenomenon but struggle for the conservation of economically significant natural wealth has a long history. The shifting of resources from the allopathic system to the traditional health care system is now a globally rising trend. In 2002 the market value of therapeutic and aromatic plants was estimated at 62 billion US$, and in 2018 it raised 131.4 billion and according to assessments, will touch 5 trillion US$ by 2050. In Japan, originally 98 members of

Pakistan occupies a key position in the international medicinal plants' trade. In the medicinal plants' import, Pakistan has a 9th position (11,350 tons), on the other side, in export the rank is 10th (8100 tons), [68]. In 2005 the plant-based medicines of the overall world herbal market were valued $18 billion which was raised to 30 billion $ in 2015 [69–71] (Table 4). China and India are the centers of the international herbal trade market, with China leading the herbal medicines export (12,0000 t) tailed by India (32,000 tones). On the other side, the therapeutic plants' primary importer is Europe [72–74]. The UK congress report indicates strong faith of the English community in the use of medicinal plants. In 2002 the UK people paid £ 126million, to the fifty thousand herbal practitioners [75]. In the US the herbal products usage trend is increasing [72]. In 2001 the overall herbal market was assessed as $ 4.2 billion [76,77]. During 2000–2006, 26 different phytopharmaceutical companies were launched by various pharmaceutical groups. The Food and Drug Administration (FDA) approved 5 novel compounds in different areas for clinical use [71,78].

Table 2 Obstacles in the establishment of Botanical gardens. S/No.

Obstacles

1 2 3 4 5 6 7 8 9 10

Funding for Botanical Gardens is insufficient Not enough taxonomists, field botanists Taxonomy is difficult to learn and to practice Requires years to accumulate literature, specimens etc. Critical resources are scattered and available to only a few workers Literature is one such critical resource Herbarium specimens are another such critical resource There are few centralized sources of information Lack of sharing information Lack of trained Human Resource to domesticate wild plants

Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005

H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx Table 3 Medicinal plant studies conducted in recent past by various researches in Pakistan. S/No. Paper title

Citations

1

[45]

2 3 4 5 6 7 8 9 10 11 12 13

14 15 16 17 18 19 20

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An ethnomedicinal survey and documentation of important medicinal folklore food phytonims of flora of Samahni valley, (Azad Kashmir) Pakistan Ethnomedicinal uses of herbs from northern part of Nara desert, Pakistan. An ethnobotanical survey of important wild medicinal plants of Hattar district Haripur, Pakistan. Ethno medicinal survey of plants from salt range (Kallar Kahar) of Pakistan. Indigenous medicinal plants used by local women in southern Himalayan regions of Pakistan. Ethnomedicinal survey for important plants of Jalalpur Jattan, district Gujrat, Punjab, Pakistan. Ethnomedicinal uses of plants by the people of Kadhi areas of Khushab, Punjab, Pakistan. Ethno medicinal survey of plants from district Bhimber Azad Jammu and Kashmir, Pakistan. Use of ethnomedicinal plants by the people living around Indus River. Quantitative ethnomedicinal study of plants used in the skardu valley at high altitude of Karakoram-Himalayan range, Pakistan. Ethnomedicine use in the war affected region of northwest Pakistan. An ethnobotanical survey of indigenous medicinal plants in Wana district South Waziristan agency, Pakistan. Ethnobotanical uses of medicinal plants for respiratory disorders among the inhabitants of Gallies–Abbottabad, Northern Pakistan. Medicinal flora and ethnoecological knowledge in the Naran Valley, Western Himalaya, Pakistan. Ethnobotanical appraisal and cultural values of medicinally important wild edible vegetables of Lesser Himalayas-Pakistan. Ethnomedicinal flora in district sialkot, Punjab, Pakistan. Ethnomedicinal uses of plants for the treatment of snake and scorpion bite in Northern Pakistan. Indigenous knowledge of medicinal plants from Leepa valley, Azad Jammu and Kashmir, Pakistan. Ethnomedicinal survey of medicinal plants of Chinglai valley, Buner district, Pakistan. Ethnopharmacological application of medicinal plants to cure skin diseases and in folk cosmetics among the tribal communities of North-West Frontier Province, Pakistan. Ethnomedicinal knowledge and relative importance of indigenous medicinal plants of Cholistan desert, Punjab Province, Pakistan. Medicinal flora of Hingol National Park, Baluchistan, Pakistan.

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emerging economy [84]. But it is a bitter fact that the contribution of researchers in Pakistan is often limited to phytochemical analysis of medicinal plants. The extraction and isolation of beneficial phytochemicals, formulation of plant-based medicines and their clinical trials are ignored areas. Up till now, not a single study is reported on the formulation/synthesis of herbal medicine/s.

[46] [47] [48] [49] [50] [51] [52] [53]

12. Phyto-medicines and future challenges In medicine discovery, numerous challenges are ahead. To achieve desired results in terms of effective medicinal compounds, ethnobotanist, ethno-chemists, and ethno-pharmacologists are required to reach stronger coordination [85,86]. Several therapeutic plants research projects running with the help of pharmaceutical industries have been stopped due to the lack of results in the last decades [87], and a huge increase in costs [88]. Modern technologies such as high throughput screening might help to overcome this impasse [89]. 1. Phyto-medicine quality control

[54] [55] [56] [57]

[58]

Medicinal plants are far from being harmless when used in the wrong way [90,91]. For the safety and efficacy of phytomedicine, knowledge about composition consistency is mandatory [92]. To present, the long-standing traditional experience of medicinal plants as botanical safety evidence is not acceptable and logical for detecting their rare or late effects. The profound lack of scientific studies on medicinal plants is one aspect criticized by allopathic medicine advocates [78].

[59]

13. Extent and causes of threats to medicinal plants in Pakistan

[60] [61]

Over-harvesting for economic purposes and phytochemical study are threatening medicinal plant richness in Pakistan. The increase in the human population is also straining these resources [93]. Table 1 has names of various institutes involved in medicinal plant research and conservation in Pakistan. To document the species for commercial harvesting, the stakeholders' through surveys have been conducted. Significant species were chosen by the Food, Agriculture and Livestock Ministry, and two main herbal amenities of Pakistan, Qarshi, and Hamdard (Tables 6 & 7). The therapeutic plants' utilization during the previous decades through the two leading Pakistan industries (Hamdard and Qarshi) indicated a peculiar array (Tables 7 & 8). Consumption and price of some high-value species (e.g. Crocus sativus L. English name saffron) increased [6].

[62] [63] [64]

[65]

[66]

11. Recent development in phytomedicines 14. Threats causes to medicinal plants survival The role of medicinal plants in the development of new allopathic compounds is remarkable (Fig. 2; Table 5). Although notable advancement has been achieved in the synthesis of compounds and biotechnology, therapeutic plants are still used as a first option to gain important compounds [79]. Plants based compounds have a 100 times higher success rate for drug development as compared to synthetic medicines [80,81], underlying the importance of ethnobotanical documentation [82]. The job of Phytochemist is to design fast and effective extraction technique/methods for the phytochemical analysis of plants. In Pakistan, a number of standard techniques are used for the extraction of active metabolites from medicinally important plants by using various solvents and techniques, including Maceration, Infusion, Percolation, Decoction, and Soxhlet. Among these the most proffered technique is Maceration [83]. Phytomedicine research and development is an ignored area in Pakistan due to the lack of interest from the government side. The government should design a vibrant policy, to create public awareness among people, especially researchers and to invest in modern biotechnological techniques, to produce valuable medicinal plants in bulk with sustainable metabolite profiles. This will help in the establishment of the medicinal plant industry in Pakistan and will also support the

14.1. Deforestation In the Himalayas, deforestation is largely caused through population pressure and associated factors: an increase in demand for cultivation land; the population of livestock; forest utilization to meet increasing demands for fodder, timber, and fuel-wood [94]. Table 4 Herbal products use in world different areas as well as expected per-year growth (%). Sales of herbal medicine

Annual growth rates by region (%)

Region

(Million US$)

Region

1985–91 1991–92 1993–98

European Union European Union Asia Japan North America Total

6000

European Union Rest of Europe

10

5

8

12

8

12

South East Asia Japan India/Pakistan

15 18 12

12 15 15

12 15 15

500 2300 2100 1500 12,400

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H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx Table 6 List of medicinal plant species suggested by MINFAL. Scientific name

Local name

Apium graveolens L. Trachyspermum ammi (L.) Sprague Cassia angustifolia M.Vahl Cassia senna L. Curcuma zedoaria (Christm.) Roscoe Foeniculum vulgare Mill. Hyoscyamus niger L. Lawsonia inermis L. Matricaria chamomilla L. Nigella sativa L. Rosa damascena Herrm.

Ajmood Ajwain Sana-maki Sana-Makki Aania Haldi Sonf Ajwain Khurasani Barg-e-Hina Gul-e-Baboona Kalonji Gul-e-Surkh

The high demand of medicinal plants also presents threats to the biodiversity of Pakistan. These can be solved by following the recommendations:

Fig. 2. Describing toxicity because of plants based products.

14.2. Dependence of local population and Afghan refugees on medicinal plants Apart from the internal demand for medicinal species, Pakistan is harboring a large number of Afghan refugees who are completely reliant on medicinal plants for their health care. Inappropriate medicinal plants storage leads often to deterioration of the collected material. Overharvesting is devastating the local resources. As an example, in Kohat, the area of Ghamkol, Peshawar Road was originally rich in Delphinium kohatense (Brühl) Munz and Berberis lyceum Royle. In the early 1980s, the Ghamkol refugee camp was established. At present, Delphinium kohatense (Brühl) Munz and Berberis lycium Royle, have completely vanished from this region [6] and many important species are threatened (Table 9).

15. Ethnic healthcare and plant extinction About 12% of Pakistan's flora is used for medicinal purposes, and more than three hundred therapeutic plants are merchandized. Some medicinal plants used in the Unani health care system, date back the ancient Greece medicines (Fig. 3) [6]. In the 1990s, the 10 leading Dawakhanas (Herbal medicines companies) of Pakistan, used more than two million kilograms of two hundred therapeutic plants per year, and the consumption of medicinal plants increased many folds during previous 2 decades (Table 9). In 1990 it was estimated that twenty-two therapeutic plants species had a sales value of US$ 229.687, while in 2002, the amount had risen to about US$ 1.9 million [3].

Table 5 Clinical trials of few medicines obtained from medicinal plants at various stages.

i. It is the duty of Government to distribute plants among the local population for plantation each year. ii. Media play its role to highlight the importance of plants. iii. To stop afforestation and overgrazing local people should be provided alternative sources like gas and electricity supply. iv. Initiation of conservation projects all over the country to create awareness among the people about the importance of wildlife for its protection. v. Medicinal plants' commercial exploitation should be checked by making and applying laws and strictly following it to safeguard the wildlife. vi. To provide literature in local language for updating the collectors about medicinal plants occurrence, collection season, medicinal importance, market values and conservation methods of plants. vii. A key point is to the identification of medicinally important species, mapping precisely their distribution, status documentation, life cycle study, and formulation of guidelines of conservation and management.

16. Medicinal plants collection chain in Pakistan In Pakistan, the therapeutic plants are gathered from wild habitats. The indigenous hoarders are unaware of the correct collection techniques; from the collection sites, these therapeutic plants pass via many traders to the national and international markets. Therefore, the prices of crude drugs have risen about 100% [6]. 17. Policy issues in relation to promoting large scale cultivation and conservation The quick floristic as well as cultural diversity loss and 30% entire material poverty state of Pakistani people, makes imperative to find a way out to their difficulties as well as to take a dynamic part in making verdicts about the natural resources management as well as their ethnicities and knowledge legal status. The policy problems as well as large scale medicinal plants cultivation, which has been applied and managed through the Ayubia National Park author, Khyber Pakhtunkhwa (KP), Pakistan as well as Applied Ethnobotany project as coordinator for ethnobotany project [6].

Drugs based on natural products at different stages of development Development stage

Plant

Bacterial

Fungal

Animal

Semi-synthetic

Total

Preclinical Phase I Phase II Phase III Pre-registration Total

46 14 41 5 2 108

12 5 4 4 0 25

7 0 0 0 0 7

7 3 10 4 0 24

27 8 11 13 2 61

99 30 66 26 4 225

18. WWF conservation and livelihood improvement collaborative project (a case study) 18.1. Ayubia national park Local and international NGOs have now started to address the threats to useful species in Pakistan. One example is the Ayubia National

Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005

H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx

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Table 7 Qarshi Industries (PVT) Limited, Pakistan consumption and selling price in 2002 & 2009. Scientific name

Common name

Average price (2002) (Rs./kg)

Average price (2009) (Rs./kg)

Quantity used (2002) (kg)

Quantity used (2009) (kg)

Plantago ovate Forssk. Achillea millefolium L. Viola odorata L. Carum carvi L. Lavandula officinalis Chaix Onosma bracteatum Wall. Berberis aristata DC. Polypodium vulgare L.

Ispaghol (HUSK) Saffron Gul-e-Banafsha Zeera siyah Ustukhuddus Gul-e-Gaozaban Zarishk Bisfaij

225 30,000 550 400 320 290 238 250

455 310,000 1000 185 329 1435 250 210

2300 20 2000 2500 3000 1500 2000 4000

1555 35 2760 16,400 419 250 550 436

Park plants' project, a collaborative effort of WWF (World Wide life Fund for Nature), people and plants combined program of UNESCO, WWF and the Royal Botanical Gardens KEW, with the objective to develop the applied ethnobotany project in order to investigate the fodder and fuelwood management status at Ayubia National Park and in its periphery [6]. Ayubia National Park (ANP) was chosen because the park is representative of many forest regions in Pakistan. In 1984, ANP was declared National Park, to conserve its attractive landscape, distinctive ecosystems as well as its high bio-diversity for education, scientific research, and leisure. The Park altitudes vary from about 3000 m (Mushkpuri top) to an average of 2300 m. Originally the area incorporated 1684 ha and was increased in 1998 to 3312 ha. The Park vegetation is believed to be one of the best examples of moist temperate forest in Pakistan. The major part of the vegetation in and around the park is greatly affected by the local population [6]. In 1997 the above-mentioned Ayubia Ethno-botany Project aimed to provide guidelines to improve fodder and fuel-wood management systems in Ayubia National Park and in the adjoining forests. The programs overall goals were: (1) to fortify the capability of working in applied ethnobotany in Pakistan with the help of a program for the preparation of young professionals as well as students, and (2) to attain healthier incorporation between conservation and development at particular field spots. The Ayubia Ethno-botany Project was conducted in 2 parts: the 1st 4-year phase (1997–2000) consisted mostly of a research component and some implementation, and the 2nd phase (2001–2004) focused on implementation [6]. The results led several nations to move their forest management approaches to Community Forestry or Joint Forest Management [95]. The results of the 1st phase were presented in a working-paper, mainly focused on social-forestry [96]. In Pakistan, structural modifications have long been in progress in the Forest Department to allow the local communities a greater role in the management of the forest. The ANP model of co-management has now been accepted by the Department of Forestry [6].

Tibb National Council (TNC) and Homoeopathy National Council (HNC) have to register their practitioners [6]. 19.1. Tibb national council (TNC) This council is responsible for the development of Tibb-e-Unani and Ayurvedic system's curriculum and examination and registers all Tabibs. Of the total of twenty-two, council members are elected by the Tabibs, and eight selected by the provincial and federal governments. The members' tenure is five years. About 45.799 Tabibs/Hakims and 537 Vaids were registered with TNC and approximately 28 acknowledged colleges of Tibb in 2005 [97]. 19.2. Homoeopathy national council (HNC) The Homoeopathy National Council has essentially the same function. The members are selected by a similar procedure as the Tibb National Council. Almost 118.000 homeopaths are registered with HNC as well as 135 acknowledged Homeopathic colleges in Pakistan [97]. 20. Complementary/traditional and alternative medicines research and development A regulation for the production, storing, importation as well as the export of Ayurvedic, Herbal, Homeopathic, Non-allopathic, and Tibb-eUnani drugs, was proposed in 2010. However, until now the production of medicines is not legislated through any government organization. Companies are self-regulating through acquiring cGMP (current good manufacturing practices) to ensure product safety as well as quality [6]. Research on major therapeutic plants is still at the level of simple documentation. At the universities, the research focus is primarily ethnobotanical documentation of plants. Studies on plant compound activity are much more recent [28,98–101]. Various institutes are conducting research on medical plants (Table 10).

medicines

21. Rights of intellectual property and indigenous knowledge protection

In Pakistan, Traditional/Complementary medicines are regulated under the Unani, Ayurvedic, and Homeopathic (UAH) 1965 Act. The

In order to safeguard the Intellectual Property (IP) of traditional users, as well as the state of Pakistan, the documentation of traditional knowledge and publication is the best method to prevent the abuse

19. Traditional/complementary regulation

and

alternative

Table 8 Medicinal plants species, prices, quantities, and values of Hamdard laboratories (Waqf) Pakistan. Scientific name

Common name

Avg. price (2002) (Rs./kg)

Avg. price (July 2008 to Jun 2009) (Rs./kg)

Qty. used (July 2008 to Jun 2009) (kg)

Qty. used (2002) (kg)

Lavandula officinalis Chaix Achillea millefolium L. Viola odorata L. Carum carvi L. Onosma bracteatum Wall. Berberis aristata DC. Polypodium vulgare L.

Ustukhuddus Baranjasif Gul-e-Banafsha Zeera siya Gul-e-Gaozaban Zarishk Bisfaij

320 285 555 495 290 238 250

408 180 635 330 2140 350 210

3625 13,200 5750 3100 2100 2500 5000

3000 6000 2000 2500 1500 2000 4000

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H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx

Table 9 Pakistan hotspots overall flora as well as herbal plants and their present status. Region

Size of flora (No of species)

Total no. of medicinally important species

Threatened flora (No. of species)

Chitral Kashmir South-Waziristan Sindh Hazara Swat Balochistan Kurram Agency

± 1600 1500 425 1185 1759 1550 1330 1200

800 900 323 700 N1000 500 700 N600

150 200 ?? 100 ?? 87 N150 N100

[102]. Hussain and Malik [102,103] have recommended several approaches; ➢ protection of indigenous Pakistan knowledge as well as therapeutic plant wealth; ➢ low price for products of traditional medicine as well as services; ➢ Wakefulness about TRIPS (Trade-Related Intellectual Property Rights) Treaty as well as Patent Laws.

22. Key developing issues Pakistan, with about 194 million population is the 6th most populated country in the world. The key issues of national development are to decrease poverty by increasing agricultural productivity and by other sectors [6]. In the forestry sector, afforestation programs are applied to provide timber and fuelwood of the country. The government is also trying to improve the education and health-care system, as well as infrastructures [18]. At the village level, the National health-care system remains however weak due to the lack of qualified staff as well as facilities. Due to the leading role of women in fuelwood and fodder collection, water carriage, and many agricultural activities, girls are still often absent from schools [104]. 23. Priorities of conservation On-one-side, forests cover 4,58-million ha. (5.2%) area of the country and on the other side, the dependency of the country is mainly on trees and NTFPs (Not Timber Forest Product) [6]. The biological resources scarcities are the country's main concern as these provide the basis of livelihood to the greater part of residents of a country. Increase in population is the main cause of the threat to biodiversity. In Table 11 some important medicinal plants of Pakistan are listed along with their present threatening status after the thorough study of literature.

Greece

Arabia

Europe

China

India

Taiwan

Japan

Pakistan

Fig. 3. Medicinal plants origin and trade chain.

24. Capacity building priorities in ethno-botany The ethnobotany is the multidisciplinary field incorporating anthropology, botany, economics, as well as linguistics. This field relates society with the environment, mainly with the plants' world. The relations are economic, communal, emblematic, religious, commercial, ritualistic or artistic. In the 1980s because of greater global concerns about the environmental crisis, the ethnobotanists give intensified attention to the indigenous management practices. A large group of ethnobotanists had been engaged at that time to know the base of such practices, the local institutions' functions related to management practices and their effect on the biodiversity conservation [96]. In September 1996, the WWF Pakistan, the National Agricultural Research Centre (NARC) and the National Herbarium (NH), organized an introductory workshop in the People and Plants UNESCO/ICIMOD Ethno-botany Project context for the Hindukush-Himalayas [18]. The applied ethnobotany's status was a significant out-put of the workshop indicating that ethnobotany in Pakistan had primarily focused on medicinal plants used by people with a comparatively slight concern for other plants wealth. This also allowed knowing that trade on a large scale, was threatening the plants' resources. But the facts concerned with resource management, tenure related aspects, ownership, access rights, harvesting methods, had not so far been examined. Discussion in the workshop with academics, conservation managers, NGO representatives, as well as traditional practitioners like ‘Hakims’ showed much curiosity to use ethnobotany as a tool to learn more about needs of people and to design better approaches for conservation. In Pakistan, high level of curiosity for applied ethnobotany development resulted directly from the Project's 2nd phase (2001–2004), on the production of a curriculum program for universities and educational centers in forestry at the national level for applied ethnobotany [6].

25. The system's prospects and limitations 25.1. Prospects Worldwide, the Unani/herbal or Greco-Arab medicine system is the developing industry. Herbal products' worldwide trade is currently exceeding amazingly about 40-billion US$ per annum [105]. Pakistan has a very rich tradition in the use of therapeutic plants to cure different diseases, which is predominantly based upon the herbal/Unani medicine system [4]. This customary medicines division has developed into a significant health care system, particularly in the country's rural/tribal parts [106]. Majority of the therapeutic plants exist in the northern subtropical forests and temperate climates of the country [107]. About 70% to 80% of the country residents, mainly of rural parts, practices CAM (Complementary and Alternative Medicine) for different diseases [106]. Along with other CAM systems like Homeopathic and Ayurvedic, the herbal/Unani system is also accepted and included by the NationalHealth-System (NHS). In the Eastern Mediterranean region, Pakistan is the single country, in which recognized Herbal/Unani education institutes are present [107]. In terms of CAM regulation at the policy level, there is a noteworthy measure. The Pakistan government has in place many organizations as well as initiatives for the purpose of support and coordination of different aspects of the sector, accompanied through NGOs (Non-Governmental Organization) as well as private sector initiatives [6]. In Pakistan, there are about 45.000 herbal specialists, in which around 3 quarters are working in rural parts [108]. In rural areas, the existence of these experts can be considered as a health care delivery source. In both private, and public sector of rural as well as urban parts about 52.600 registered Herbal/Unani practitioners are working. Approximately 360 Herbal/ Tibbi healthcare units/dispensaries, as well as clinics, are providing free treatment under the provincial government health departments [107].

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Table 10 Various institutes conducting researches in different areas on medical plants. Collection, identification and vouchering

Phytochemcal studies

Pharmacological studies

Data Base of ethnobotany

Standardization, quality control and safety assurance

Cultivation of Propagation therapeutic plants and tissue culture

Botany Departments of Various Universities of Pakistan Hamdard University, Bait-ul-Hikmah, Karachi Quaid-e-Azam University, Islamabad Herbarium, University of Karachi, Karachi

Chemistry and Pharmacology Departments of various Universities of Pakistan

Al-Majeed College of Eastern Medicines, Hamdard University, Karachi

Hamdard University, Karachi

Hamdard Laboratories, Karachi

NARC, Islamabad

AKRSP, Pakistan

International Center for Chemical Research, Institute of Chemistry, University of Pakistan Council for Scientific and Industrial Laboratories, Peshawar

Hamdard University, Karachi

Botany Departments of various Universities of Pakistan Hamdard University, Karachi

HEJ Research Institute, University of Karachi, Karachi National Institute of Health, Islamabad Pharmacognosy Department, University of Karachi, Karachi

Hamdard University Karachi

NIAB, Faisalabad

Forest Department, Peshawar, KPK

NARC, Islamabad

NIBGE, Faisalabad

IUCN, Pakistan

National Institute of Health, Islamabad PARC, Islamabad

PCSIR laboratories, Karachi

MACP, Pakistan

University of Malakand, KPK

Palas Conservation and Development Project (PCDP) Kohistan, KPK, Pakistan

NARC (National Agriculture & Research Council, Islamabad) NIH (National Institute of Health, Islamabad) PFI (Pakistan Forest Institute, Peshawar) PMNH (Pakistan Museum of Natural History, Islamabad)

HEJ Research Institute, University of Karachi

Pakistan Forest Institute, Peshawar, KPK

National Institute of Health, Islamabad

Pharmacology and Pharmacognosy Departments of various Universities of Pakistan

Conservation

The Aga Khan Medical University, Karachi

PMNH, Islamabad

SDC/IC, Pakistan

University of Agriculture, Faisalabad

Qarshi Industries, Hattar University of Malakand, KPK

WWF, Pakistan

University of Agriculture, Peshawar University of Veterinary and Animal Sciences, Lahore

Time is necessary to plan training as well as capacity-building projects for the herbal/Unani medicines practitioners because they need education in order to bring practitioners into the mainstream as well as to elevate their position in the public. In the export of medicinal plants, Pakistan is among the 10th foremost exporters [106]. At the regional and international level, a partnership can be established on the shared primary interest basis. For instance, sustainable use and conservation of resources can be attained with the help of community involvement. It is the need of time to involve NGOs in bioprospecting as well as sharing of benefit [108]. There is a need for close cooperation among the stakeholders comprising allopathic specialists, herbal drugs practitioners, pharmacologists, ethnobotanists, phytochemist, agronomists as well as other associated disciplines.

Recent evidences although inadequate, recommend that doctors may equitably admit certain therapies of traditional medicines. Pakistan's National Health Policy recently put forward a proposal for bringing modification in the present commandment of Tibb for recognizing the postgraduate level education. Furthermore, policy documents also have some omissions on revenue distribution, intellectual property rights, herbal products registration as well as other associated legislature [6]. Moreover, to collect and store therapeutic plants, ethnic people lack training and therefore the sustainability is endangered. The ethnic knowledge about the identification and therapeutic plants uses are vanishing. Deforestation and extinction threat are alarming as the forest-covered area is reducing day-by-day because of less. 26. Recommendations

25.2. Limitations The relationship between the providers of traditional medicines and the conventional allopathic physician are conflicting as well as antagonistic [109] because allopathic medicines have not ever been in traditional medicines favor. The herbal practitioners are strongly discouraged by limiting their access, marking these practitioners as anti-scientific as well as enacting punishments on them. Certain reasonable aspects for this denunciation comprise absence of training, education, regulation, as well as the scientific base for traditional medicine specialists. Similarly, accountability shortage in the profession of medical, both traditional as well as complimentary, result in impostor's medicine, hence giving practitioners of traditional medicines a depraved tag as well as lowering their respect in public [110].

The following measures are suggested priority basis revive and promote medicinal plant use and conservation: (i) Development of proposals for National Policy on Traditional Medicines (ii) Initiation of projects based on conservation to identify system weaknesses and strengths; (iii) Collaboration in different projects with NGOs and government agencies; (iv) Development of linkages among various stakeholders; (v) General NRM Program - key mutualisms identification for management, e.g. pollinators and seed dispersers, regeneration ecology, symbiotic microorganisms; (vi) Ethno-botany programs.

Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005

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H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx

Table 11 Present status of some important medicinal plants in Pakistan. S/No. Botanical name of plants

Conservation status

1

Endangered, threatened [111–113]

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63

Abies pindrow (Royle ex D.Don) Royle Abutilon indicum (L.) Sweet Acacia modesta Wall. Acacia nilotica (L.) Delile Acacia senegal (L.) Willd Achillea millefolium L. Aconitum chasmanthum Stapf ex Holmes Aconitum heterophyllum Wall. ex. Royle Aconitum violaceum Jacq. ex Stapf Acorus calamus L. Actaea spicata L. Justicia adhatoda L. Aesculus indica (Wall. ex Cambess.) Hook. Albizia lebbek (L.) Benth Alhagi maurorum Medik. Althaea officinalis L. Anagallis arvensis L. Angelica glauca Edgew. Argemone mexicana L. Artemisia maritima L. Artemisia sieversiana Ehrh. Azadirachta indica A. Juss. Berberis lycium Royle. Berberis pseudumbellata R. Parker Bergenia ciliata (Haw.) Sternb. Betula utilis D.Don Bistorta amplexicaulis (D.Don) Greene Boerhavia procumbens Banks ex Roxb. Bombax ceiba L. Buxus papillosa C.K.Schneid. Calotropis gigantea (L.) Dryand. Calotropis procera (Aiton) Dryand. Capparis decidua (Forssk.) Edgew. Capparis spinosa L. Capsella bursa pastoris (L.) Medik. Carthamus tinctorius L. Cassia fistula L. Cedrus deodara (Roxb. ex Lamb) G. Don. Chenopodium album L. Cichorium intybus L. Citrullus colocynthis (L.) Schrad Clematis orientalis L. Colchicum luteum Baker Convolvulus arvensis L. Conyza bonariensis (L.) Cronquist Coriandrum sativum L. Cymbopogon jwarancusa (Jones) Schult. Cynodon dactylon (L.) Pers. Daphne mucronata Royle Daphne oleoides Schreb. Datura alba Rumph. ex Nees Datura metel L. Datura stramonium L. Diospyros lotus L. Dodonaea viscosa (L.) Jacq Eclipta alba (L) Hassk. Ephedra gerardiana Wall. ex Stapf Ephedra intermedia Schrenk & C.A. Mey Epilobium hirsutum L. Erigeron multiradiatus (Lindl. ex DC.) Benth. & Hook.f. Euphorbia helioscopia L. Fagonia cretica L. Ferula assa-foetida L.

Vulnerable [112] Vulnerable, endangered [112,114,115] Vulnerable, endangered [111,112,115,116] Threatened [113] Rare [111] Critically endangered [117] Critically endangered, endangered, Rare [111,114,116,118] Vulnerable [119,120] Endangered [119] Rare [111] Rare [121] Vulnerable, endangered [111,112,114,116,122] Endangered [115] Rare [115] Rare [121] Rare [123] Critically endangered [116,124] Critically endangered [116] Endangered, vulnerable [118,124] Vulnerable [121] Threatened [113] Endangered, vulnerable [111,114] Endangered [120] Endangered, Critically endangered [111,114,116,118,119] Endangered [111,124] Endangered [111,119] Rare [123] Endangered [115] Rare [121] Rare [121] Critically endangered, rare [115,116] Vulnerable [125] Rare [125] Vulnerable [126] Rare [121] Vulnerable [115] Endangered, rare [114,122] Rare [126] Endangered [116] Vulnerable [127] Endangered [128] Endangered [116] Rare [126] Vulnerable [114] Vulnerable [116] Threatened [129] Vulnerable [126] Vulnerable [116,119] Endangered [112] Infrequent [115] Rare [115] Vulnerable [116] Endangered, rare [111,116] Endangered [115] Vulnerable [114] Endangered, vulnerable [119,124] Critically endangered [116] Rare [114] Vulnerable [114] Vulnerable [116] Rare [121] Rare [121]

Table 11 (continued) S/No. Botanical name of plants

Conservation status

64 65 66 67 68 69 70 71 72

Rare [130] Vulnerable [112,115] Endangered, vulnerable [115] Endangered [115] Critically endangered [116] Endangered [116] Vulnerable [116] Vulnerable [116] Endangered, rare [111,114]

83 84

Ficus benghalensis L. Ficus carica L. Ficus palmata Forssk. Ficus religiosa L. Foeniculum vulgare Mill. Fritillaria cirrhosa D.Don Fumaria indica (Hausskn.) Pugsley Galium aparine L. Geranium wallichianum D.Don ex Sweet Grewia asiatica L. Hedera nepalensis K. Koch Elaeagnus rhamnoides (L.) A. Nelson Hyoscyamus niger L. Hypericum perforatum L. Impatiens balsamina L. Impatiens glandulifera Royle Juglans regia L. Juniperus communis L. Juniperus polycarpos (Kom.) Kitam. Malva sylvestris L. Melia azedarach L.

85 86 87 88 89

Mentha arvensis L. Mentha longifolia (L.) L. Morchella conica Fries Morchella esculenta (L.) Pers. Morus alba L.

90 91 92 93 94

Morus macroura Miq. Morus nigra L. Ocimum basilicum L. Olea ferruginea Wall. ex Aitch. Opuntia dillenii (Ker Gawler) Haworth Opuntia monacantha (Willd.) Haw. Paeonia emodi Royle Peganum harmala L. Periploca aphylla Decne. Picrorhiza kurroa Royle ex Benth Pinus wallichiana A.B. Jacks. Pistacia khinjuk Stocks Plantago major L. Plantago ovata Forssk Plantago lanceolata L. Polygonatum verticillatum (L.) All. Polygonum plebeium R.Br. Polypogon monspeliensis (L.) Desf. Pongamia pinnata (L.) Pierre Portulaca quadrifida L. Prosopis cineraria (L.) Druce Prunella vulgaris L. Prunus persica (L.) Batsch Punica granatum L. Quercus floribunda Lindl. ex A. Camus Quercus incana Bartram

73 74 75 76 77 78 79 80 81 82

95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130

Rhazya stricta Decene Rhododendron anthopogon D. Don. Ricinus communis L. Rosa webbiana Wall ex Royle. Rumex hastatus D. Don. Salix alba L. Salvadora oleoides Decne. Salvadora persica L. Sarcococca pruniformis Lindl Saussurea lappa (Decne.) Sch.Bip. Saussurea costus (Falc.) Lipsch. Senecio laetus Edgew. Skimmia laureola (DC.) Siebold & Zucc. ex Walp. Solanum americanum Mill. Solanum surattense Burm. f.

Threatened [113] Critically endangered [116] Endangered [124] Endangered [128] Vulnerable, endangered [114,116] Infrequent [112] Vulnerable [111] Threatened, endangered [113,116] Endangered [128] Threatened [113] Rare [121] Endangered, critically endangered, Rare [112,114–116,126] Rare [114] Endangered [116] Rare [119] Endangered [111] Endangered, rare, vulnerable, Threatened [111–113,115] Endangered, rare [112,130] Vulnerable [112,115] Rare [121] Endangered, rare [111,112,126] Endangered [118] Vulnerable [115] Endangered [111,118] Endangered [118] Critically endangered [116] Endangered [124] Endangered, threatened [111,113] Threatened [113] Vulnerable [116] Rare [111] Vulnerable [116] Endangered [119] Vulnerable [114,116] Vulnerable [114] Rare [121] Vulnerable [116] Threatened [129] Critically endangered [116] Rare [115] Vulnerable [115,116] Endangered, vulnerable, threatened [112,113,130] Vulnerable, endangered, threatened [111–113] Endangered [115] Threatened [113] Rare [115] Rare [131] Rare [114] Vulnerable [130] Overharvested [114] Rare [121] Endangered [112] Endangered, threatened [111,113,124] Endangered [127] Critically endangered [116] Endangered [116] Critically endangered [116] Vulnerable [116]

Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005

H.A. Jan et al. / Acta Ecologica Sinica xxx (2020) xxx Table 11 (continued) S/No. Botanical name of plants

Conservation status

131 132 133 134

Vulnerable [115] Vulnerable [125] Rare, vulnerable [111,116] Endangered, threatened [113,122]

135 136 137 138 139 140 141 142 143 144

Sonchus asper (L.) Hill Tamarindus indica L. Tamarix aphylla (L.) H.Karst. Taraxacum campylodes G.E. Haglund Taxus baccata L. Tribulus terrestris L. Urtica dioica L. Valeriana jatamansi Jones. Verbena officinalis L. Viola pilosa Blume Vitis vinifera L. Withania coagulans (Stocks) Dunal. Withania somnifera (L.) Dunnal. Xanthium strumarium L.

Rare [121] Critically endangered, rare [112,116] Endangered, rare, critically endangered [114,116,118] Vulnerable [116] Rare, vulnerable [112,121] Over harvested [114,119] Endangered, rare [121,132] Endangered, vulnerable [115,122] Endangered [116] Rare [114,126]

Providing opportunities for stakeholder participation in regionalized resources management, willingness to understand communities' complex livelihood and social strategies, traditional knowledge respect as part of plans of resources management, ensure the access of communities to scientific innovations, and opportunities for the development of forest management practices; i) Encouragement of the cultivation of important wild medicinal plant species; ii) Implementation of lessons learned from stories of success for the training of collectors, honor intellectual property rights and minimizing post-harvest damages; iii) To encourage clinical studies. Funding There was no funding body for this research work. This work was supported financially by the researchers from their own salaries or pocket money. Consent for publication Not applicable – no personal data are included in this manuscript. Declaration of Competing Interest The authors declare that they have no competing financial interest. Acknowledgment The authors are thankful to Islamia College Peshawar, Pakistan and the Higher Education Commission (HEC), Pakistan. We are thankful to all those, who help us in the present work. References [1] S.I. Ali, M.A. Qaiser, Phytogeographical analysis of the phanerogams of Pakistan and Kashmir, Proceed. Royal Soc. Edinb. Sec. B 89 (1986) 89–101. [2] Z.K. Shinwari, S.S. Gilani, K. Kohjoma, T. Nakaike, Status of medicinal plants in Pakistani Hindukush Himalayas, Proceedings of Nepal – Japan Joint Symposium on Conservation and Utilization of Himalayan Medicinal Resources 2000, pp. 257–264. [3] Z.K. Shinwari, S.S. Gilani, M. Shoukat, Ethnobotanical resources and implications for curriculum, Proceedings of Workshop on Curriculum Development in Applied Ethnobotany 2002, pp. 2–4 , May. [4] World Health Organization, Legal Status of Traditional Medicine and Complementary and Alternative Medicine: A World Review, WHO, Geneva, 2001. [5] S. Bhardwaj, S.K. Ghakar, Ethnomedicinal plants used by the tribals of Mizoram to cure cut and wound, IJTK. 4 (1) (2005) 75–80. [6] Z.K. Shinwari, Medicinal plants research in Pakistan, J. Med. Plant Res. 4 (3) (2010) 161–176.

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Please cite this article as: H.A. Jan, S. Jan, R.W. Bussmann, et al., Complementary and alternative medicine research, prospects and limitations in Pakistan: A literature..., Acta Ecologica Sinica, https://doi.org/10.1016/j.chnaes.2019.12.005