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Consensus of local knowledge on medicinal plants among traditional healers in Mayiladumparai block of Theni District, Tamil Nadu, India
Journal of Ethnopharmacology 134 (2011) 354–362
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Consensus of local knowledge on medicinal plants among traditional healers in Mayiladumparai block of Theni District, Tamil Nadu, India P. Pandikumar, M. Chellappandian, S. Mutheeswaran, S. Ignacimuthu ∗ Division of Ethnopharmacology, Entomology Research Institute, Loyola College, Nungambakkam, Chennai 600034, India
a r t i c l e
i n f o
Article history: Received 23 September 2010 Received in revised form 30 November 2010 Accepted 18 December 2010 Available online 28 December 2010 Keywords: Consensus analysis Traditional medicine Theni District Tamil Nadu India
a b s t r a c t Aim of the study: The role of ethnobotany in drug discovery is huge but there are criticisms over such studies due to their qualitative nature. The present study is aimed at quantitatively abstracting the medicinal plant knowledge of the healers trained in traditional ways, in Mayiladumparai block of Theni District, Tamil Nadu, India. Materials and methods: The interviews and field observations were carried out in all the 18 village panchayaths from January to June 2010, consisting of 148 field days. The interviews were conducted with 80 traditional healers, after obtaining prior informed consent. Successive free listing was used to interview the informants. The informant consensus factor (Fic ) was calculated to estimate the use variability of medicinal plants. Fidelity index and Cultural importance index were also calculated to analyze the data. Results: This study recorded the ethno-medicinal usage of 142 ethno-species belonging to 62 families that were used to prepare 504 formulations. Jaundice had the highest Fic value than all the illness categories studied. Phyllanthus spp. was the highly cited medicinal plant to treat jaundice and had high fidelity index value. This was followed by Senna angustifolia and Terminalia chebula as laxatives. The highly cited medicinal plants in each group with high Fic value were Pongamia pinnata (antiseptic), Aerva lanata (antidote and snakebite), Blepharis maderaspatensis (cuts and wounds), Abutilon indicum (hemorrhoids), Ruta graveolens (spiritual medicine), Ocimum tenuiflorum (cough), and Solanum trilobatum (pulmonary ailments). Phyllanthus spp., was the most culturally significant species according to this index, followed by Borassus flebellifer. Conclusion: The process of drug discovery has become highly expensive and post-approval and postmarketing withdrawal of drugs is continuing. In such scenario, reverse pharmacology is considered an attractive option. The medicinal plants enumerated in this study with high number of citations and high Fic values for illness categories might give some useful leads for further biomedical research. © 2010 Elsevier Ireland Ltd. All rights reserved.
1. Introduction The usage of medicinal plants for primary health care needs by millions of people in developing world is still occupying a prominent position (WHO, 2002). The folk remedies are considered readily available, cheap and time tested. India is rich in ethnic diversity and has a well practiced knowledge of herbal medicines. The global demand for medicinal plants is increasing and, in India alone, the market is expanding at an annual rate of 20% (Uprety et al., 2010), but only a little is known about its use-patterns (Ramawat and Goyal, 2008). For the past three decades, much information has been stored in the field of ethnobotany purely by qualitative overviews on human–plant relationship. Many criticisms are raised over the paternalistic and simplistic nature of these studies and
∗ Corresponding author. Tel.: +91 44 2817 8348; fax: +91 44 2817 5566. E-mail address: [email protected] (S. Ignacimuthu). 0378-8741/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.jep.2010.12.027
credibility for further biomedical evaluation and natural resource management is doubted (Ragupathy and Newmaster, 2009). Hence, there is a felt need for the application of quantitative measures of reliability in the field of ethnobotany. Herbal medicines often contain many ingredients whose effects on the biochemical pathways are unknown. At the same time, the traditional remedies may contain critical clues for disorders that have been refractory to western medicine (Lazar, 2004). The interest in nature as a source for potential chemotherapeutic agent continues (Gurib-Fakim, 2006) and nearly half of the small molecules approved in this decade are natural products (Kong et al., 2009). In the search for novel molecules, traditional knowledge on medicinal plants has helped in many instances. Biguanides for diabetes (Witters, 2001), artemisinin for malaria (Harvey, 1999) and a recently adopted satiety inducer, P-57 from Hoodia gordonii, a medicinal plant used by the African tribes to avoid feeling of hunger while hunting (Saklani and Kutty, 2008) are some notable examples.
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Fig. 1. Location of study area, Mayiladumparai block in Theni District.
The present study is aimed at quantitatively abstracting the medicinal plant knowledge of the healers trained in traditional ways, in Mayiladumparai block of Theni District. Previous works conducted in this district were primarily devoted to tribal medicine and they were qualitative (Ignacimuthu et al., 2008). 2. Materials and methods 2.1. Study area The study area (9◦ 33 –9◦ 39 N; 77◦ 21 –77◦ 29 E) is located on the eastern offshoot of Western Ghats running in Theni district of Tamil Nadu (Fig. 1). The altitude ranges from 560 (Thumakkundu) to 1560 (Meghamalai) m.s.l. It consists of 18 village panchayaths and there are no urban areas. It is in the shadow region of SW monsoon and gets maximum rainfall at NE monsoon. Tropical dry deciduous, moist deciduous and semi evergreen forests are the forest types of this area and Meghamalai Reserve forest is a part of this area. Cultivation of Cashew nuts, silk-cotton, coconut, and brick making are the important sources for revenue. The population of this area is 67,863 and the density of population is 108/sq.km; this is lower for that district. The male:female ratio is 1:0.92, and the literacy rate is 61.84 for male and 38.16 for female. This block has 3 primary health centers and 14 subcenters (Anonymous, 2009).
Hospitals are available only in Theni which is nearly 40 km away from the study area. 2.2. Interviews The interviews and field observations were carried out in all the 18 village panchayaths according to the methods of Alexiades (1996), and Heinrich et al. (2009). The fieldwork was conducted from January to June 2010, consisting of 148 field days. The interview was focused on healers (Heinrich et al., 1992) who were trained in the traditional way and still giving treatment to general public. The government trained healers were excluded since only traditional healers were included in this study. The purpose and nature of the program were described to them in a simple language to obtain prior informed consent. Eighty seven traditional medical practitioners were identified in the study area and 80 of them were willing to share their knowledge. These 80 informants were included for further interviews. Successive free listing was used to interview the informants (Heinrich et al., 2009). In some instances the informants were requested to collect specimens of the plants that they knew or to show the plant species on site. The questionnaire consisted of two parts. The first part dealt with the demographic profile of the informants such as name, age, sex, years of experience, education and occupation. The second part dealt with
P. Pandikumar et al. / Journal of Ethnopharmacology 134 (2011) 354–362
their knowledge on medicinal plants; in this, the informants were asked to describe the medicines used by them, the local name of the plants, parts used, method of preparing drugs, mode of usage and the diseases treated. In this part, the symptomatology of the diseases was also documented. The questions were asked in person and the answers were recorded. As a recognition of their collaboration we had given them medicinal plant seedlings to grow in home gardens and made a commitment to publish a free booklet on their traditional knowledge in local language, Tamil. All the interview protocols were carried out in accordance with the guidelines of ISE code of ethics for ethnobiological research (2006). Voucher specimens for all the plants and crude drugs were collected and stored in the herbarium of Entomology Research Institute, Loyola College, Chennai for future reference. The botanical nomenclatures of the specimens were confirmed using regional floras (Gamble, 1997; Matthew, 1999) and International Plant Names Index (2010). 2.3. Analysis of the data The ethnobotanical indices were founded on a basic structure, Use Report (UR), which can be described as “informant (i) mentions the use of the species (s) in the use category (u)” (Kufer et al., 2005). The indications/symptoms were grouped into illness categories based on the emic (in a culture-specific way) perceptions of the informants. These data were assessed in three ways. i. To test the consistency of informant’s knowledge in treating a particular illness category, calculation of consensus factor (Fic ) was followed (Trotter and Logan, 1986). This factor can be given as: Fic =
Nur − Nt Nur − 1
where Nur is the number of use reports of informants for particular illness category, and Nt is the number of species used for particular illness by all informants. This factor ranges from zero to one, where increasing values indicate high rate of informant consensus. ii. To assess the importance of individual species in each group fidelity level (Friedman et al., 1986) was calculated. Fidelity level (FL) =
N p
N
× 100
where Np is the number of informants citing the use of the plant for a particular illness and N is the total number of informants citing the species for any illness. The calculation of fidelity level was limited to those plants with at least three citations for a particular illness category. Increasing values of FL for a species indicate its uniqueness to treat a particular illness. iii. Culturally important species as medicines were identified by cultural importance index (CI) of Tardio and Pardo-DeSantayana (2008). It is a most objective index because it considers diversity of uses along with the consensus of informant. It can be defined by the following formula:
CI =
Table 1 Demographic profile of the informants included in the survey. N
%
Age Under 30 30–40 41–50 51–75 Above 75
2 12 40 22 4
2.5 15.0 50.0 27.5 5.0
Experience <5 years 5–20 years 21–40 years >40 years
4 35 32 9
5.0 43.8 40.0 11.2
Sex Men Women
68 12
85.0 15.0
Education Uneducated Primary school Secondary school High school
38 22 12 8
47.5 27.5 15.0 10.0
Occupation Agricultural employees Full time practitioners Self-employed Spiritual healers and astrologers
21 33 18 8
26.2 41.2 22.5 10.0
40
Number of species
356
30
20 a
10
b 0 0
10
20
30
Number of informants Fig. 2. Distribution of local knowledge among traditional healers.
3. Results 3.1. Demographic profile of the informants Fifty percent of the knowledge holders were between 41 and 50 years of age and only small portion (5.0%) of the informants was over 75. A major portion of the informants (95%) had at least five years of experience in treating people with their medicine. There is unevenness in male:female ratio (1:0.17). A considerable part of the knowledge holders was uneducated (47.5%) or had only primary school education (27.5%). Only 41.25% of the traditional healers had been doing this as a full time job (Table 1). The AUC of species reported by one or two key informants was 25.0 and by more than two informants was 153.0 (Fig. 2).
In Unc URui U=U1 i=i1
N
where NC is the total number of different illness categories (of each i species), UR is the total number of use reports for each species, and N is the total number of informants.
3.2. Plants and preparation of remedies This study recorded the ethno-medicinal usage of 142 ethnospecies belonging to 62 families which were used to prepare 504 formulations. The local knowledge of traditional healers in Mayiladumaprai block of Theni District on medicinal plants is listed
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Table 2 Different gathering environments of the species to prepare formulations. Gathering environments
Number of species
%
Waste lands, courtyards, road sides Field edges and fences Cultivated lands Scrub jungles Forest elements Not present in the area
39 29 29 21 11 13
27.65 20.56 20.56 14.89 7.09 9.21
Fig. 3. Different methods of preparing medicines (a) internal and (b) external.
in Supplementary data 1. Each species had an average of 2.70 different usages. The average number of informants reporting the medicinal usage for a plant was 6.13. A major portion of the medicinal plants (69.49%) used by them was growing wild followed by plants which were cultivated (21.27%). The plants that had more number of use reports were Phyllanthus spp. (Phyllanthus amarus and Phyllanthus urinaria) (36), Borassus flebellifer (32), Piper nigrum (32), Aerva lanata (27), and Andrographis paniculata (23). Species that showed a high versatility of uses were Piper nigrum (11 different uses), Azadirachta indica (10), Acalypha indica (10), and Curcuma longa (10). Regarding the local frequency of species the informants reported 89.35% of species to be very common or common. Regarding the gathering areas of medicinal plants, a major portion (68.77%) of the medicinal plants was collected from areas which were disturbed by anthropogenic activities (Table 2). Fifteen different types of remedies were recorded in the present study; seven of which were for external use and eight were for internal use. The healers prepare medicines whenever needed rather than preparing and storing them in readily treatable forms such as tablets, powder, and jams (Fig. 3a). In the case of external usage medicines prescribed with spiritual backgrounds have high value (Fig. 3b). The healers were using earthen or stone made apparatus for preparing these formulations (Fig. 4).
Fig. 4. Apparatus used for preparing formulations: (a) stone made pestle and mortars of different sizes for crushing; (b) a traditional healer (Mr. Sultan Bai) showing earthen made distillation unit.
lower than mean Fic plus standard deviation were assigned as ‘illness categories with low Fic values’. The remaining illness categories were assigned as ‘illness categories with moderate Fic values’.
3.3. Quantification of the data
3.3.1. Illness categories with high Fic values Jaundice had the highest Fic value than all the illness categories studied. Phyllanthus spp. was the highly cited medicinal plant to treat jaundice and had high fidelity level. This plant was also recommended by the healers to strengthen liver. This was followed by Senna angustifolia and Terminalia chebula as laxatives. In the case of adjuvants, Borassus flebellifer had high number of citations followed by Piper nigrum, Cuminum cyminum, and Zingiber officinale. The highly cited medicinal plants in each group were Pongamia pinnata (antiseptic), Aerva lanata (antidote and snakebite), Blepharis maderaspatensis (cuts and wounds), Abutilon indicum (hemorrhoids), Ruta graveolens (spiritual medicine), Ocimum tenuiflorum (cough), and Solanum trilobatum (pulmonary ailments).
Based on Fic values calculated, the illness categories were classified into three arbitrary groups as proposed by Moerman (2007), with a modification (Table 3). The illness categories that had a high Fic values greater than mean Fic plus standard deviation (0.393 ± 0.293) were assigned as ‘illness categories with high Fic values’. The illness categories which had low Fic values that were
3.3.2. Illness categories with moderate Fic values In anti-rheumatic category, Plumbago zeylanica was the highly cited medicinal plant followed by Cardiospermum helicacabum and Vitex negundo. In this category Clerodendrum phlomidis and Delonix elata were used only to treat joint disorders. In febrifuges, Evolvulus alsinoides and Mollugo nudicaulis were the highly cited
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Table 3 Fic values for different illness categories treated by the healers of Mayiladumparai block. Illness category
Number of plants
Number of citations
Fic
Illness categories with high Fic values Jaundice Laxative Adjuvants Antiseptic Antidote Cuts and wounds Hemorrhoid treatment Snake bite remedy Spiritual medicine Cough medicine Pulmonary ailments
3 4 15 8 18 6 13 10 5 10 19
27 20 78 28 66 20 45 33 15 32 63
0.923 0.842 0.818 0.740 0.738 0.736 0.727 0.718 0.714 0.709 0.709
Illness categories with moderate Fic values Anti-rheumatic Febrifuge Liver ailments Diabetes Antithrombotic Digestive ailments Venereal ailments Blood purifier Antidiarrheal Coolants Urinary ailments Dermatological ailments Gastrointestinal ailments Head ache Immune enhancers Orthopedics Paralysis Gynecological ailments Heart medicine Tooth ache remedy Aphrodisiac
16 9 5 11 6 15 8 15 7 12 14 16 21 19 11 5 10 7 4 8 5
43 21 11 24 12 31 16 27 12 21 24 26 34 28 16 7 14 9 5 10 6
0.642 0.600 0.600 0.565 0.545 0.533 0.533 0.461 0.454 0.450 0.434 0.400 0.393 0.333 0.333 0.333 0.307 0.250 0.250 0.222 0.200
Illness categories with low Fic values Analgesics Abortificiant Anticonvulsive Burn dressing Ear medicine Eye ailments Hypotensive Oral ailments Others Psycological ailments Reproductive ailments Vertigo medicine
10 1 5 2 1 6 2 1 3 2 5 1
11 1 5 2 1 6 2 1 3 2 5 1
0.100 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
plants (Table 4). The plants with more than five citations for the same use in other groups were Gymnema sylvestre (diabetes), Pergularia daemia (digestive ailments), Cynodon dactylon (blood purifier), Euphorbia hirta (antidiarrheal), Musa paradisiaca (urinary ailments), Andrographis paniculata (dermatological ailments), Gynandropsis pentaphylla (head ache), and Azadirachta indica (immune enhancer).
3.3.3. Culturally important medicinal species Table 5 shows the cultural importance index of the 25 most relevant and useful species of this area. Phyllanthus spp., was the most culturally significant species according to this index. This was followed by Borassus flebellifer. The sugar extracted from the sap of this plant’s inflorescence substituted the cane sugar to prepare medicines. In the 25 most culturally important species of this area, 14 were herbs, six were shrubs and five were trees. Although, the number of herbs were more, the mean CI index of trees was high (0.247 ± 0.03) over that of herbs (0.223 ± 0.02). These results are in accordance with previous reports (Moerman, 1994).
3.4. Perception and dissemination of knowledge In our study area, the major knowledge holders were poorly literate and the transfer of knowledge was mainly by oral means. Their unique ways to transfer the knowledge to others were classified into four groups for descriptive purpose (Supplementary data 1). 3.4.1. Giving names with cues for which they can be used The folk genera were named by indicating their application. The species such as Aristolochia indica, Corallocarpus epigeaeus and Selaginella plana were named after ‘karuda’, indicating brahminy kite, a symbolic enemy of snakes and hence poisonous. These three plants were used for the treatment of snakebites. Likewise, Clerodendrum phlomidis and Delonix elata were named with a prefix ‘vatha’ (=disorders of joints; Sanskrit) to identify their utility to treat joint disorders. 3.4.2. By correlating with other effective medicines The medicinal plants were compared with the utility of bhasmas (mineral based preparations in Indian system of traditional
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Table 4 Fidelity level of interesting medicinal plants of the study area. Illness categories
Plants
Adjuvants
Borassus flebellifer* (100.00), Piper nigrum (25.00)*, Cuminum cyminum (100.00)*, Zingiber officinale (28.57)*, Sesamum indicum (100.00)*, Piper longum (100.00), Coriandrum sativum (50.00), Nigella sativa (60.00) Euphorbia hirta (41.66)* Aerva lanata (44.44)*, Aristolochia indica (47.61)*, Andrographis paniculata (34.78)*, Piper nigrum (25.00)*, Azima tetracantha (100.00), Corallocarpus epigeaeus (80.00), Acalypha indica (16.66), Allium cepa (25.00), Calotropis gigantea (75.00) Bambusa bambos (75.00), Dodonaea viscosa (75.00) Plumbago zeylanica (66.66)*, Cardiospermum helicacabum (55.55)*, Vitex negundo (71.42)*, Clerodendrum phlomidis (100.00)*, Boerhavia diffusa (75.00), Delonix elata (100.00) Pongamia pinnata* (47.61), Curcuma longa* (36.36), Azadirachta indica (19.04) Ruta graveolens* (100.00), Quercus infectoria* (71.42), Acorus calamus (75.00) Cynodon dactylon* (50.00), Enicostemma axillere* (62.50), Phyllanthus spp. (8.33), Pongamia pinnata (14.28) Pedalium murex (66.66), Phyllanthus emblica (33.33), Terminalia chebula (20.00) Ocimum tenuiflorum* (50.00), Zingiber officinale* (28.57), Solanum trilobatum (30.76), Piper nigrum (9.37) Blepharis maderaspatensis* (52.94), Pongamia pinnata (19.04), Curcuma longa (18.18) Andrographis paniculata* (30.43), Cocas nucifera (100.00) Gymnema sylvestre* (77.77), Syzygium cumini (50.00), Cassia auriculata (50.00) Pergularia daemia* (80.00), Zingiber officinale (19.04), Trianthema portulacastum (50.00) Evolvulus alsinoides (80.00), Mollugo nudicaulis (100.00), Coriandrum sativum (50.00), Ocimum tenuiflorum (16.66) Coccinia indica (57.14), Cassia occidentalis (42.85), Cissus quadrangularis (25.00), Solanum nigrum (60.00), Toddalia asiatica (100.00) Euphorbia hirta (25.00) Gynandropsis pentaphylla* (55.55), Allium sativum (33.33) Abutilon indicum* (83.33), Achyranthes aspera* (54.54), Cissus quadrangularis* (33.33), Mimosa pudica* (50.00), Allium cepa (25.00), Argemone mexicana (50.00), Punica granatum (100.00) Azadirachta indica* (23.80) Phyllanthus spp.* (69.44) Cassia angustifolia* (84.61), Terminalia chebula* (46.66) Phyllanthus spp.* (16.66) Solanum trilobatum* (61.53), Azadirachta indica* (23.80), Acalypha indica* (27.77), Ocimum tenuiflorum* (27.77), Zingiber officinale* (23.80), Acacia pennata (66.66), Mukia madarasepatana (50.00), Piper nigrum (12.50), Achyranthus aspera (27.77), Cynodon dactylon (30.00), Plectranthus ambonicus (37.50), Leucas aspera (42.85) Aerva lanata* (40.74), Aristolochia indica* (42.85), Andrographis paniculata (17.39), Piper nigrum (9.37) Solnum virginianum (50.00) Musa paradisiaca* (83.33), Aerva lanata (11.11) Aloe vera (80.00), Syzygium cumini (50.00)
Antidiarrheal Antidote Antithrombotic Antirheumatic Antiseptic Spiritual medicine Blood purifier Coolants Cough medicine Cuts & wounds Dermatological ailments Diabetes Digestive ailments Febrifuge Gastrointestinal ailments Gynecological ailments Head ache Hemorrhoid treatment Immune enhancers Jaundice Laxative Liver ailments Pulmonary ailments
Snake bite remedy Toothe ache remedy Urinary ailments Veneral ailments
Fidelity level is mentioned in parentheses; species mentioned with asterisk have ≥5 citations for that illness category.
medicine). The red oxide of iron is given as a remedy to treat jaundice, anemia and taken as appetizer. The healers correlate Eclipta prostrata as having the power of iron and thus recommend it to treat jaundice and anemia. 3.4.3. By symbolic stories The medicinal properties of the species were correlated with the stories in epics. The leaves of Ocimum tenuiflorum were offered to lord Vishnu, a Hindu god who dwells in moist place to keep him warm and to prevent the diseases of cold, such as pulmonary ailments. 3.4.4. By its signatures Due to high mucilage content, the cut leaves of Blepharis maderaspatensis stick with each other and hence its usage against cut wounds. In many of the traditional communities there is a strong belief that ‘the remedies are not far from their causes’. Some of the healers in this community also maintain this belief. Acalypha indica (Kuppaimeni = plant in garbage) grows near garbage. The healers were recommending this plant as a remedy for skin diseases and poisons of scorpion and centipedes, which are promoted by that environment. 4. Discussion 4.1. Demographic profile of the informants Plants are not used in cultural vacuum and thus it becomes necessary to include the socio-cultural context of the particular group (Heinrich et al., 2009). Women in this study area knew to treat some
Table 5 Cultural importance index of 25 most relevant species. Name of the plant
CII
Name of the plant
CII
Phyllanthus spp. Borassus flebellifer Piper nigrum Aerva lanata Andrographis paniculata Curcuma longa Aristolochia indica Azadirachta indica Pongamia pinnata Zingiber officinale Acalypha indica Ocimum tenuiflorum Blepharis maderaspatensis
0.437 0.375 0.350 0.325 0.287 0.262 0.262 0.262 0.262 0.262 0.225 0.224 0.212
Terminalia chebula Cassia angustifolia Solanum trilobatum Abutilon indicum Allium cepa Cissus quadrangularis Euphorbia hirta Mimosa pudica Phyllanthus emblica Plumbago zeylanica Achyranthes aspera Cynodon dactylon
0.187 0.187 0.162 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.137 0.125
pediatric and gynecological ailments but they did not treat the community as a healer. This caused the unevenness in male: female ratio. The reduced revenue generation through this job caused dependence on other jobs for their livelihood. There was a growing trend among indigenous people to abandon traditional knowledge and values for alternatives with apparently greater economic and social opportunities (Godoy, 1994). We hypothesize that since the revenue derived directly by holding traditional knowledge is not up to their expectation, there is a possibility for the erosion of their knowledge in future. The AUC of species reported by one to two key informants was low compared to the species reported by more than two informants; this indicated (Fig. 2) that the knowledge was distributed homogeneously unlike in some previously reported results, which showed heterogeneity and unevenness in distribution (Signorini et al., 2009).
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4.2. Plants and preparation of remedies The plants which were utilized by the healers in the study area were mainly growing as wild and a lesser number was cultivated. The plants growing in anthropogenic environments were holding the major portion of their traditional knowledge (Table 2). The reason can be described in terms of cultural erosion (Quilan and Quilan, 2007), a worldwide phenomenon occurring at a huge rate in indigenous societies. Traditional knowledge is a dynamic entity which is hybridized with new social, economic, political, and ecological phenomena caused by globalization (Sears et al., 2007). This caused the introduction of exotic species in their medicinal flora and loss of knowledge on the utility of native species (Smith-Oka, 2008; Molares and Ladio, 2009). Limiting forest access to the indigenous communities might also be a reason for the loss of knowledge on native species by causing reduced forest value (Benz et al., 2000). The effectiveness of the plants prescribed as medicines with spiritual background is not simply a consequence of their pharmacology but a varying combination of pharmacology and its cultural and traditional meanings (Moerman, 2007).
paradisiaca (Patnakar et al., 2008), Aerva lanata (Soundararajan et al., 2006) (urinary ailments), Cissus quadrangularis (Jainu et al., 2006), Solanum nigrum (Jainu and Devi, 2006) (gastrointestinal ailments), and Azadirachta indica (Goswami et al., 2010) (immune enhancer) had at least three citations for the same use and pharmacological support. Illness categories with low values indicate that the species mentioned might be an artifact, or have fallen into disuse because of cultural adaptation, or be ineffective for conditions reported, or have become rare, or might belong to cultural fringe of knowledge (Heinrich et al., 2009). 4.3.3. Culturally important medicinal species Cultural importance index is the most objective index because it is based on the informant’s consensus and additionally considers diversity of uses. A culturally important species can be described as a species desired, preferred or with an affective evaluation by most of the members of this culture (Tardio and Pardo-De-Santayana, 2008). It is an efficient tool for highlighting those species with a high agreement for the culture of the whole survey area. The present study showed that most of the traditionally important species were growing commonly in anthropogenic environments.
4.3. Quantification of the data 4.3.1. Illness categories with high Fic values Previous quantitative study conducted among Malasars of Tamil Nadu had also indicated high Fic value for jaundice and usefulness of Phyllanthus amarus (Ragupathy et al., 2008). Previous in vitro and in vivo studies conducted supported the utility of this plant in treating viral hepatitis (Venkateswaran et al., 1987). The high usage of laxatives is due to their perception that they purify stomach to cure gastrointestinal and dermatological disorders. In adjuvant group, Piper nigrum, Piper longum and Zingiber officinale alone or in combination known as ‘thrikatu’ beneficially increased the absorptive surface of the small intestine (Prakash and Srinivasan, 2010), increased the intestinal absorption of Curcumin (Suresh and Srinivasan, 2010), pefloxacin (Dama et al., 2008), ampicillin and norfloxacin (Janakiraman and Manavalan, 2008). A flavanoid glycoside (CC-I) isolated from Cuminum cyminum increased the bioavailability of rifampicin (Sachin et al., 2007). Of the five citations for Nigella sativa, three were prescribed as adjuvant for hemorrhoid treatment. This was supported by a preclinical study in which the treatment with Nigella sativa oil reduced the proinflammatory cytokine levels in TNBS induced experimental colitis (Isik et al., 2010). Bites and stings by poisonous animals are a common problem for most of the villagers working in fields and forests (Amiguet et al., 2005). If they get any wounds or poisonous bites in fields, the treatment with the medicinal plants is the easily accessible form of medicine. This might be the reason for the high Fic value for the illness categories, viz. antidote, antiseptic, cuts, wounds and snakebite remedies. High prevalence of bronchial asthma and upper respiratory tract infections (Anonymous, 2009) in the study area might be the reason for high Fic for that illness category. The emic way of classification includes hemorrhoids with many other diseases that caused lower gastrointestinal bleeding. This knowledge can be exploited for prospecting novel drugs where surgery is the mainstay of intervention (Barnert and Messmann, 2008). 4.3.2. Illness categories with moderate Fic values In illness categories of this group the species such as Cardiospermum helicacabum (Sheeba and Asha, 2009), Vitex negundo (Zheng et al., 2009) (anti-rheumatic), Phyllanthus spp. (Gopi and Setty, 2010) (liver ailments), Gymnema sylvestre (Leach, 2007), Syzygium cumini (Helmstadter, 2008), Senna auriculata (Gupta et al., 2010) (diabetes), Euphorbia hirta (Galvez et al., 1993) (antidiarrheal), Musa
4.4. Perception and dissemination of knowledge An indigenous person looks at the forest with innumerable memories, associations, and anecdotes. Such aspects of phytodiversity are invisible and inaudible to most of us (Jain, 2000). Their ways of perceiving, testing and transmitting the knowledge on nature is mainly verbal and unique. In such orally transmitted systems, mnemonic cues (memory-aids) are essential to the viability of knowledge transmission (Shepard, 2002). Although, the doctrine of signatures was considered as pre-scientific, its reinterpretation considered it as a device used for knowledge transmission, especially in pre-literate societies and as an attempt to explain why the plant is useful for a particular ailment. Most of the signatures are post-hoc appellations rather than a priori clues (Bennett, 2007) and a way of understanding and retaining quite complex memories (Donald, 1997). Some of the works published earlier have recorded such type of knowledge transmission in India (Jain, 2000) and other countries (Dafni and Lev, 2002). The plants that are both efficacious and easy to remember are more likely to be maintained in the pharmacopoeia of non-literate societies through time (Shepard, 2002). 5. Conclusion The process of drug discovery has become highly expensive and post-approval and post-marketing withdrawal of drugs is continuing. In such a scenario, reverse pharmacology is considered an attractive option because most of the natural products developed in this way are part of routinely used medicines; thus tolerance and safety of these products are relatively better known than other synthetic chemical entities entering first-in-man studies (Patwardhan and Mashelkar, 2009). Further biomedical research on the medicinal plants mentioned in this study especially those with high number of citations and high Fic values for illness categories might provide some potential leads to fulfill the needs of global health priorities. Acknowledgments We are thankful to the traditional healers in Mayiladumparai block of Theni District for their participation and sharing of their valuable knowledge. We are grateful to the Department of
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AYUSH, Ministry of Health and Family Welfare (Sanction Number: Z.15017/40/2008-E&C) for providing financial support for this study. We are thankful to the reviewers for their suggestions to improve the quality of the manuscript.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.jep.2010.12.027.
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Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jethpharm
Consensus of local knowledge on medicinal plants among traditional healers in Mayiladumparai block of Theni District, Tamil Nadu, India P. Pandikumar, M. Chellappandian, S. Mutheeswaran, S. Ignacimuthu ∗ Division of Ethnopharmacology, Entomology Research Institute, Loyola College, Nungambakkam, Chennai 600034, India
a r t i c l e
i n f o
Article history: Received 23 September 2010 Received in revised form 30 November 2010 Accepted 18 December 2010 Available online 28 December 2010 Keywords: Consensus analysis Traditional medicine Theni District Tamil Nadu India
a b s t r a c t Aim of the study: The role of ethnobotany in drug discovery is huge but there are criticisms over such studies due to their qualitative nature. The present study is aimed at quantitatively abstracting the medicinal plant knowledge of the healers trained in traditional ways, in Mayiladumparai block of Theni District, Tamil Nadu, India. Materials and methods: The interviews and field observations were carried out in all the 18 village panchayaths from January to June 2010, consisting of 148 field days. The interviews were conducted with 80 traditional healers, after obtaining prior informed consent. Successive free listing was used to interview the informants. The informant consensus factor (Fic ) was calculated to estimate the use variability of medicinal plants. Fidelity index and Cultural importance index were also calculated to analyze the data. Results: This study recorded the ethno-medicinal usage of 142 ethno-species belonging to 62 families that were used to prepare 504 formulations. Jaundice had the highest Fic value than all the illness categories studied. Phyllanthus spp. was the highly cited medicinal plant to treat jaundice and had high fidelity index value. This was followed by Senna angustifolia and Terminalia chebula as laxatives. The highly cited medicinal plants in each group with high Fic value were Pongamia pinnata (antiseptic), Aerva lanata (antidote and snakebite), Blepharis maderaspatensis (cuts and wounds), Abutilon indicum (hemorrhoids), Ruta graveolens (spiritual medicine), Ocimum tenuiflorum (cough), and Solanum trilobatum (pulmonary ailments). Phyllanthus spp., was the most culturally significant species according to this index, followed by Borassus flebellifer. Conclusion: The process of drug discovery has become highly expensive and post-approval and postmarketing withdrawal of drugs is continuing. In such scenario, reverse pharmacology is considered an attractive option. The medicinal plants enumerated in this study with high number of citations and high Fic values for illness categories might give some useful leads for further biomedical research. © 2010 Elsevier Ireland Ltd. All rights reserved.
1. Introduction The usage of medicinal plants for primary health care needs by millions of people in developing world is still occupying a prominent position (WHO, 2002). The folk remedies are considered readily available, cheap and time tested. India is rich in ethnic diversity and has a well practiced knowledge of herbal medicines. The global demand for medicinal plants is increasing and, in India alone, the market is expanding at an annual rate of 20% (Uprety et al., 2010), but only a little is known about its use-patterns (Ramawat and Goyal, 2008). For the past three decades, much information has been stored in the field of ethnobotany purely by qualitative overviews on human–plant relationship. Many criticisms are raised over the paternalistic and simplistic nature of these studies and
∗ Corresponding author. Tel.: +91 44 2817 8348; fax: +91 44 2817 5566. E-mail address: [email protected] (S. Ignacimuthu). 0378-8741/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.jep.2010.12.027
credibility for further biomedical evaluation and natural resource management is doubted (Ragupathy and Newmaster, 2009). Hence, there is a felt need for the application of quantitative measures of reliability in the field of ethnobotany. Herbal medicines often contain many ingredients whose effects on the biochemical pathways are unknown. At the same time, the traditional remedies may contain critical clues for disorders that have been refractory to western medicine (Lazar, 2004). The interest in nature as a source for potential chemotherapeutic agent continues (Gurib-Fakim, 2006) and nearly half of the small molecules approved in this decade are natural products (Kong et al., 2009). In the search for novel molecules, traditional knowledge on medicinal plants has helped in many instances. Biguanides for diabetes (Witters, 2001), artemisinin for malaria (Harvey, 1999) and a recently adopted satiety inducer, P-57 from Hoodia gordonii, a medicinal plant used by the African tribes to avoid feeling of hunger while hunting (Saklani and Kutty, 2008) are some notable examples.
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355
Fig. 1. Location of study area, Mayiladumparai block in Theni District.
The present study is aimed at quantitatively abstracting the medicinal plant knowledge of the healers trained in traditional ways, in Mayiladumparai block of Theni District. Previous works conducted in this district were primarily devoted to tribal medicine and they were qualitative (Ignacimuthu et al., 2008). 2. Materials and methods 2.1. Study area The study area (9◦ 33 –9◦ 39 N; 77◦ 21 –77◦ 29 E) is located on the eastern offshoot of Western Ghats running in Theni district of Tamil Nadu (Fig. 1). The altitude ranges from 560 (Thumakkundu) to 1560 (Meghamalai) m.s.l. It consists of 18 village panchayaths and there are no urban areas. It is in the shadow region of SW monsoon and gets maximum rainfall at NE monsoon. Tropical dry deciduous, moist deciduous and semi evergreen forests are the forest types of this area and Meghamalai Reserve forest is a part of this area. Cultivation of Cashew nuts, silk-cotton, coconut, and brick making are the important sources for revenue. The population of this area is 67,863 and the density of population is 108/sq.km; this is lower for that district. The male:female ratio is 1:0.92, and the literacy rate is 61.84 for male and 38.16 for female. This block has 3 primary health centers and 14 subcenters (Anonymous, 2009).
Hospitals are available only in Theni which is nearly 40 km away from the study area. 2.2. Interviews The interviews and field observations were carried out in all the 18 village panchayaths according to the methods of Alexiades (1996), and Heinrich et al. (2009). The fieldwork was conducted from January to June 2010, consisting of 148 field days. The interview was focused on healers (Heinrich et al., 1992) who were trained in the traditional way and still giving treatment to general public. The government trained healers were excluded since only traditional healers were included in this study. The purpose and nature of the program were described to them in a simple language to obtain prior informed consent. Eighty seven traditional medical practitioners were identified in the study area and 80 of them were willing to share their knowledge. These 80 informants were included for further interviews. Successive free listing was used to interview the informants (Heinrich et al., 2009). In some instances the informants were requested to collect specimens of the plants that they knew or to show the plant species on site. The questionnaire consisted of two parts. The first part dealt with the demographic profile of the informants such as name, age, sex, years of experience, education and occupation. The second part dealt with
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their knowledge on medicinal plants; in this, the informants were asked to describe the medicines used by them, the local name of the plants, parts used, method of preparing drugs, mode of usage and the diseases treated. In this part, the symptomatology of the diseases was also documented. The questions were asked in person and the answers were recorded. As a recognition of their collaboration we had given them medicinal plant seedlings to grow in home gardens and made a commitment to publish a free booklet on their traditional knowledge in local language, Tamil. All the interview protocols were carried out in accordance with the guidelines of ISE code of ethics for ethnobiological research (2006). Voucher specimens for all the plants and crude drugs were collected and stored in the herbarium of Entomology Research Institute, Loyola College, Chennai for future reference. The botanical nomenclatures of the specimens were confirmed using regional floras (Gamble, 1997; Matthew, 1999) and International Plant Names Index (2010). 2.3. Analysis of the data The ethnobotanical indices were founded on a basic structure, Use Report (UR), which can be described as “informant (i) mentions the use of the species (s) in the use category (u)” (Kufer et al., 2005). The indications/symptoms were grouped into illness categories based on the emic (in a culture-specific way) perceptions of the informants. These data were assessed in three ways. i. To test the consistency of informant’s knowledge in treating a particular illness category, calculation of consensus factor (Fic ) was followed (Trotter and Logan, 1986). This factor can be given as: Fic =
Nur − Nt Nur − 1
where Nur is the number of use reports of informants for particular illness category, and Nt is the number of species used for particular illness by all informants. This factor ranges from zero to one, where increasing values indicate high rate of informant consensus. ii. To assess the importance of individual species in each group fidelity level (Friedman et al., 1986) was calculated. Fidelity level (FL) =
N p
N
× 100
where Np is the number of informants citing the use of the plant for a particular illness and N is the total number of informants citing the species for any illness. The calculation of fidelity level was limited to those plants with at least three citations for a particular illness category. Increasing values of FL for a species indicate its uniqueness to treat a particular illness. iii. Culturally important species as medicines were identified by cultural importance index (CI) of Tardio and Pardo-DeSantayana (2008). It is a most objective index because it considers diversity of uses along with the consensus of informant. It can be defined by the following formula:
CI =
Table 1 Demographic profile of the informants included in the survey. N
%
Age Under 30 30–40 41–50 51–75 Above 75
2 12 40 22 4
2.5 15.0 50.0 27.5 5.0
Experience <5 years 5–20 years 21–40 years >40 years
4 35 32 9
5.0 43.8 40.0 11.2
Sex Men Women
68 12
85.0 15.0
Education Uneducated Primary school Secondary school High school
38 22 12 8
47.5 27.5 15.0 10.0
Occupation Agricultural employees Full time practitioners Self-employed Spiritual healers and astrologers
21 33 18 8
26.2 41.2 22.5 10.0
40
Number of species
356
30
20 a
10
b 0 0
10
20
30
Number of informants Fig. 2. Distribution of local knowledge among traditional healers.
3. Results 3.1. Demographic profile of the informants Fifty percent of the knowledge holders were between 41 and 50 years of age and only small portion (5.0%) of the informants was over 75. A major portion of the informants (95%) had at least five years of experience in treating people with their medicine. There is unevenness in male:female ratio (1:0.17). A considerable part of the knowledge holders was uneducated (47.5%) or had only primary school education (27.5%). Only 41.25% of the traditional healers had been doing this as a full time job (Table 1). The AUC of species reported by one or two key informants was 25.0 and by more than two informants was 153.0 (Fig. 2).
In Unc URui U=U1 i=i1
N
where NC is the total number of different illness categories (of each i species), UR is the total number of use reports for each species, and N is the total number of informants.
3.2. Plants and preparation of remedies This study recorded the ethno-medicinal usage of 142 ethnospecies belonging to 62 families which were used to prepare 504 formulations. The local knowledge of traditional healers in Mayiladumaprai block of Theni District on medicinal plants is listed
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357
Table 2 Different gathering environments of the species to prepare formulations. Gathering environments
Number of species
%
Waste lands, courtyards, road sides Field edges and fences Cultivated lands Scrub jungles Forest elements Not present in the area
39 29 29 21 11 13
27.65 20.56 20.56 14.89 7.09 9.21
Fig. 3. Different methods of preparing medicines (a) internal and (b) external.
in Supplementary data 1. Each species had an average of 2.70 different usages. The average number of informants reporting the medicinal usage for a plant was 6.13. A major portion of the medicinal plants (69.49%) used by them was growing wild followed by plants which were cultivated (21.27%). The plants that had more number of use reports were Phyllanthus spp. (Phyllanthus amarus and Phyllanthus urinaria) (36), Borassus flebellifer (32), Piper nigrum (32), Aerva lanata (27), and Andrographis paniculata (23). Species that showed a high versatility of uses were Piper nigrum (11 different uses), Azadirachta indica (10), Acalypha indica (10), and Curcuma longa (10). Regarding the local frequency of species the informants reported 89.35% of species to be very common or common. Regarding the gathering areas of medicinal plants, a major portion (68.77%) of the medicinal plants was collected from areas which were disturbed by anthropogenic activities (Table 2). Fifteen different types of remedies were recorded in the present study; seven of which were for external use and eight were for internal use. The healers prepare medicines whenever needed rather than preparing and storing them in readily treatable forms such as tablets, powder, and jams (Fig. 3a). In the case of external usage medicines prescribed with spiritual backgrounds have high value (Fig. 3b). The healers were using earthen or stone made apparatus for preparing these formulations (Fig. 4).
Fig. 4. Apparatus used for preparing formulations: (a) stone made pestle and mortars of different sizes for crushing; (b) a traditional healer (Mr. Sultan Bai) showing earthen made distillation unit.
lower than mean Fic plus standard deviation were assigned as ‘illness categories with low Fic values’. The remaining illness categories were assigned as ‘illness categories with moderate Fic values’.
3.3. Quantification of the data
3.3.1. Illness categories with high Fic values Jaundice had the highest Fic value than all the illness categories studied. Phyllanthus spp. was the highly cited medicinal plant to treat jaundice and had high fidelity level. This plant was also recommended by the healers to strengthen liver. This was followed by Senna angustifolia and Terminalia chebula as laxatives. In the case of adjuvants, Borassus flebellifer had high number of citations followed by Piper nigrum, Cuminum cyminum, and Zingiber officinale. The highly cited medicinal plants in each group were Pongamia pinnata (antiseptic), Aerva lanata (antidote and snakebite), Blepharis maderaspatensis (cuts and wounds), Abutilon indicum (hemorrhoids), Ruta graveolens (spiritual medicine), Ocimum tenuiflorum (cough), and Solanum trilobatum (pulmonary ailments).
Based on Fic values calculated, the illness categories were classified into three arbitrary groups as proposed by Moerman (2007), with a modification (Table 3). The illness categories that had a high Fic values greater than mean Fic plus standard deviation (0.393 ± 0.293) were assigned as ‘illness categories with high Fic values’. The illness categories which had low Fic values that were
3.3.2. Illness categories with moderate Fic values In anti-rheumatic category, Plumbago zeylanica was the highly cited medicinal plant followed by Cardiospermum helicacabum and Vitex negundo. In this category Clerodendrum phlomidis and Delonix elata were used only to treat joint disorders. In febrifuges, Evolvulus alsinoides and Mollugo nudicaulis were the highly cited
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Table 3 Fic values for different illness categories treated by the healers of Mayiladumparai block. Illness category
Number of plants
Number of citations
Fic
Illness categories with high Fic values Jaundice Laxative Adjuvants Antiseptic Antidote Cuts and wounds Hemorrhoid treatment Snake bite remedy Spiritual medicine Cough medicine Pulmonary ailments
3 4 15 8 18 6 13 10 5 10 19
27 20 78 28 66 20 45 33 15 32 63
0.923 0.842 0.818 0.740 0.738 0.736 0.727 0.718 0.714 0.709 0.709
Illness categories with moderate Fic values Anti-rheumatic Febrifuge Liver ailments Diabetes Antithrombotic Digestive ailments Venereal ailments Blood purifier Antidiarrheal Coolants Urinary ailments Dermatological ailments Gastrointestinal ailments Head ache Immune enhancers Orthopedics Paralysis Gynecological ailments Heart medicine Tooth ache remedy Aphrodisiac
16 9 5 11 6 15 8 15 7 12 14 16 21 19 11 5 10 7 4 8 5
43 21 11 24 12 31 16 27 12 21 24 26 34 28 16 7 14 9 5 10 6
0.642 0.600 0.600 0.565 0.545 0.533 0.533 0.461 0.454 0.450 0.434 0.400 0.393 0.333 0.333 0.333 0.307 0.250 0.250 0.222 0.200
Illness categories with low Fic values Analgesics Abortificiant Anticonvulsive Burn dressing Ear medicine Eye ailments Hypotensive Oral ailments Others Psycological ailments Reproductive ailments Vertigo medicine
10 1 5 2 1 6 2 1 3 2 5 1
11 1 5 2 1 6 2 1 3 2 5 1
0.100 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
plants (Table 4). The plants with more than five citations for the same use in other groups were Gymnema sylvestre (diabetes), Pergularia daemia (digestive ailments), Cynodon dactylon (blood purifier), Euphorbia hirta (antidiarrheal), Musa paradisiaca (urinary ailments), Andrographis paniculata (dermatological ailments), Gynandropsis pentaphylla (head ache), and Azadirachta indica (immune enhancer).
3.3.3. Culturally important medicinal species Table 5 shows the cultural importance index of the 25 most relevant and useful species of this area. Phyllanthus spp., was the most culturally significant species according to this index. This was followed by Borassus flebellifer. The sugar extracted from the sap of this plant’s inflorescence substituted the cane sugar to prepare medicines. In the 25 most culturally important species of this area, 14 were herbs, six were shrubs and five were trees. Although, the number of herbs were more, the mean CI index of trees was high (0.247 ± 0.03) over that of herbs (0.223 ± 0.02). These results are in accordance with previous reports (Moerman, 1994).
3.4. Perception and dissemination of knowledge In our study area, the major knowledge holders were poorly literate and the transfer of knowledge was mainly by oral means. Their unique ways to transfer the knowledge to others were classified into four groups for descriptive purpose (Supplementary data 1). 3.4.1. Giving names with cues for which they can be used The folk genera were named by indicating their application. The species such as Aristolochia indica, Corallocarpus epigeaeus and Selaginella plana were named after ‘karuda’, indicating brahminy kite, a symbolic enemy of snakes and hence poisonous. These three plants were used for the treatment of snakebites. Likewise, Clerodendrum phlomidis and Delonix elata were named with a prefix ‘vatha’ (=disorders of joints; Sanskrit) to identify their utility to treat joint disorders. 3.4.2. By correlating with other effective medicines The medicinal plants were compared with the utility of bhasmas (mineral based preparations in Indian system of traditional
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Table 4 Fidelity level of interesting medicinal plants of the study area. Illness categories
Plants
Adjuvants
Borassus flebellifer* (100.00), Piper nigrum (25.00)*, Cuminum cyminum (100.00)*, Zingiber officinale (28.57)*, Sesamum indicum (100.00)*, Piper longum (100.00), Coriandrum sativum (50.00), Nigella sativa (60.00) Euphorbia hirta (41.66)* Aerva lanata (44.44)*, Aristolochia indica (47.61)*, Andrographis paniculata (34.78)*, Piper nigrum (25.00)*, Azima tetracantha (100.00), Corallocarpus epigeaeus (80.00), Acalypha indica (16.66), Allium cepa (25.00), Calotropis gigantea (75.00) Bambusa bambos (75.00), Dodonaea viscosa (75.00) Plumbago zeylanica (66.66)*, Cardiospermum helicacabum (55.55)*, Vitex negundo (71.42)*, Clerodendrum phlomidis (100.00)*, Boerhavia diffusa (75.00), Delonix elata (100.00) Pongamia pinnata* (47.61), Curcuma longa* (36.36), Azadirachta indica (19.04) Ruta graveolens* (100.00), Quercus infectoria* (71.42), Acorus calamus (75.00) Cynodon dactylon* (50.00), Enicostemma axillere* (62.50), Phyllanthus spp. (8.33), Pongamia pinnata (14.28) Pedalium murex (66.66), Phyllanthus emblica (33.33), Terminalia chebula (20.00) Ocimum tenuiflorum* (50.00), Zingiber officinale* (28.57), Solanum trilobatum (30.76), Piper nigrum (9.37) Blepharis maderaspatensis* (52.94), Pongamia pinnata (19.04), Curcuma longa (18.18) Andrographis paniculata* (30.43), Cocas nucifera (100.00) Gymnema sylvestre* (77.77), Syzygium cumini (50.00), Cassia auriculata (50.00) Pergularia daemia* (80.00), Zingiber officinale (19.04), Trianthema portulacastum (50.00) Evolvulus alsinoides (80.00), Mollugo nudicaulis (100.00), Coriandrum sativum (50.00), Ocimum tenuiflorum (16.66) Coccinia indica (57.14), Cassia occidentalis (42.85), Cissus quadrangularis (25.00), Solanum nigrum (60.00), Toddalia asiatica (100.00) Euphorbia hirta (25.00) Gynandropsis pentaphylla* (55.55), Allium sativum (33.33) Abutilon indicum* (83.33), Achyranthes aspera* (54.54), Cissus quadrangularis* (33.33), Mimosa pudica* (50.00), Allium cepa (25.00), Argemone mexicana (50.00), Punica granatum (100.00) Azadirachta indica* (23.80) Phyllanthus spp.* (69.44) Cassia angustifolia* (84.61), Terminalia chebula* (46.66) Phyllanthus spp.* (16.66) Solanum trilobatum* (61.53), Azadirachta indica* (23.80), Acalypha indica* (27.77), Ocimum tenuiflorum* (27.77), Zingiber officinale* (23.80), Acacia pennata (66.66), Mukia madarasepatana (50.00), Piper nigrum (12.50), Achyranthus aspera (27.77), Cynodon dactylon (30.00), Plectranthus ambonicus (37.50), Leucas aspera (42.85) Aerva lanata* (40.74), Aristolochia indica* (42.85), Andrographis paniculata (17.39), Piper nigrum (9.37) Solnum virginianum (50.00) Musa paradisiaca* (83.33), Aerva lanata (11.11) Aloe vera (80.00), Syzygium cumini (50.00)
Antidiarrheal Antidote Antithrombotic Antirheumatic Antiseptic Spiritual medicine Blood purifier Coolants Cough medicine Cuts & wounds Dermatological ailments Diabetes Digestive ailments Febrifuge Gastrointestinal ailments Gynecological ailments Head ache Hemorrhoid treatment Immune enhancers Jaundice Laxative Liver ailments Pulmonary ailments
Snake bite remedy Toothe ache remedy Urinary ailments Veneral ailments
Fidelity level is mentioned in parentheses; species mentioned with asterisk have ≥5 citations for that illness category.
medicine). The red oxide of iron is given as a remedy to treat jaundice, anemia and taken as appetizer. The healers correlate Eclipta prostrata as having the power of iron and thus recommend it to treat jaundice and anemia. 3.4.3. By symbolic stories The medicinal properties of the species were correlated with the stories in epics. The leaves of Ocimum tenuiflorum were offered to lord Vishnu, a Hindu god who dwells in moist place to keep him warm and to prevent the diseases of cold, such as pulmonary ailments. 3.4.4. By its signatures Due to high mucilage content, the cut leaves of Blepharis maderaspatensis stick with each other and hence its usage against cut wounds. In many of the traditional communities there is a strong belief that ‘the remedies are not far from their causes’. Some of the healers in this community also maintain this belief. Acalypha indica (Kuppaimeni = plant in garbage) grows near garbage. The healers were recommending this plant as a remedy for skin diseases and poisons of scorpion and centipedes, which are promoted by that environment. 4. Discussion 4.1. Demographic profile of the informants Plants are not used in cultural vacuum and thus it becomes necessary to include the socio-cultural context of the particular group (Heinrich et al., 2009). Women in this study area knew to treat some
Table 5 Cultural importance index of 25 most relevant species. Name of the plant
CII
Name of the plant
CII
Phyllanthus spp. Borassus flebellifer Piper nigrum Aerva lanata Andrographis paniculata Curcuma longa Aristolochia indica Azadirachta indica Pongamia pinnata Zingiber officinale Acalypha indica Ocimum tenuiflorum Blepharis maderaspatensis
0.437 0.375 0.350 0.325 0.287 0.262 0.262 0.262 0.262 0.262 0.225 0.224 0.212
Terminalia chebula Cassia angustifolia Solanum trilobatum Abutilon indicum Allium cepa Cissus quadrangularis Euphorbia hirta Mimosa pudica Phyllanthus emblica Plumbago zeylanica Achyranthes aspera Cynodon dactylon
0.187 0.187 0.162 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.137 0.125
pediatric and gynecological ailments but they did not treat the community as a healer. This caused the unevenness in male: female ratio. The reduced revenue generation through this job caused dependence on other jobs for their livelihood. There was a growing trend among indigenous people to abandon traditional knowledge and values for alternatives with apparently greater economic and social opportunities (Godoy, 1994). We hypothesize that since the revenue derived directly by holding traditional knowledge is not up to their expectation, there is a possibility for the erosion of their knowledge in future. The AUC of species reported by one to two key informants was low compared to the species reported by more than two informants; this indicated (Fig. 2) that the knowledge was distributed homogeneously unlike in some previously reported results, which showed heterogeneity and unevenness in distribution (Signorini et al., 2009).
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4.2. Plants and preparation of remedies The plants which were utilized by the healers in the study area were mainly growing as wild and a lesser number was cultivated. The plants growing in anthropogenic environments were holding the major portion of their traditional knowledge (Table 2). The reason can be described in terms of cultural erosion (Quilan and Quilan, 2007), a worldwide phenomenon occurring at a huge rate in indigenous societies. Traditional knowledge is a dynamic entity which is hybridized with new social, economic, political, and ecological phenomena caused by globalization (Sears et al., 2007). This caused the introduction of exotic species in their medicinal flora and loss of knowledge on the utility of native species (Smith-Oka, 2008; Molares and Ladio, 2009). Limiting forest access to the indigenous communities might also be a reason for the loss of knowledge on native species by causing reduced forest value (Benz et al., 2000). The effectiveness of the plants prescribed as medicines with spiritual background is not simply a consequence of their pharmacology but a varying combination of pharmacology and its cultural and traditional meanings (Moerman, 2007).
paradisiaca (Patnakar et al., 2008), Aerva lanata (Soundararajan et al., 2006) (urinary ailments), Cissus quadrangularis (Jainu et al., 2006), Solanum nigrum (Jainu and Devi, 2006) (gastrointestinal ailments), and Azadirachta indica (Goswami et al., 2010) (immune enhancer) had at least three citations for the same use and pharmacological support. Illness categories with low values indicate that the species mentioned might be an artifact, or have fallen into disuse because of cultural adaptation, or be ineffective for conditions reported, or have become rare, or might belong to cultural fringe of knowledge (Heinrich et al., 2009). 4.3.3. Culturally important medicinal species Cultural importance index is the most objective index because it is based on the informant’s consensus and additionally considers diversity of uses. A culturally important species can be described as a species desired, preferred or with an affective evaluation by most of the members of this culture (Tardio and Pardo-De-Santayana, 2008). It is an efficient tool for highlighting those species with a high agreement for the culture of the whole survey area. The present study showed that most of the traditionally important species were growing commonly in anthropogenic environments.
4.3. Quantification of the data 4.3.1. Illness categories with high Fic values Previous quantitative study conducted among Malasars of Tamil Nadu had also indicated high Fic value for jaundice and usefulness of Phyllanthus amarus (Ragupathy et al., 2008). Previous in vitro and in vivo studies conducted supported the utility of this plant in treating viral hepatitis (Venkateswaran et al., 1987). The high usage of laxatives is due to their perception that they purify stomach to cure gastrointestinal and dermatological disorders. In adjuvant group, Piper nigrum, Piper longum and Zingiber officinale alone or in combination known as ‘thrikatu’ beneficially increased the absorptive surface of the small intestine (Prakash and Srinivasan, 2010), increased the intestinal absorption of Curcumin (Suresh and Srinivasan, 2010), pefloxacin (Dama et al., 2008), ampicillin and norfloxacin (Janakiraman and Manavalan, 2008). A flavanoid glycoside (CC-I) isolated from Cuminum cyminum increased the bioavailability of rifampicin (Sachin et al., 2007). Of the five citations for Nigella sativa, three were prescribed as adjuvant for hemorrhoid treatment. This was supported by a preclinical study in which the treatment with Nigella sativa oil reduced the proinflammatory cytokine levels in TNBS induced experimental colitis (Isik et al., 2010). Bites and stings by poisonous animals are a common problem for most of the villagers working in fields and forests (Amiguet et al., 2005). If they get any wounds or poisonous bites in fields, the treatment with the medicinal plants is the easily accessible form of medicine. This might be the reason for the high Fic value for the illness categories, viz. antidote, antiseptic, cuts, wounds and snakebite remedies. High prevalence of bronchial asthma and upper respiratory tract infections (Anonymous, 2009) in the study area might be the reason for high Fic for that illness category. The emic way of classification includes hemorrhoids with many other diseases that caused lower gastrointestinal bleeding. This knowledge can be exploited for prospecting novel drugs where surgery is the mainstay of intervention (Barnert and Messmann, 2008). 4.3.2. Illness categories with moderate Fic values In illness categories of this group the species such as Cardiospermum helicacabum (Sheeba and Asha, 2009), Vitex negundo (Zheng et al., 2009) (anti-rheumatic), Phyllanthus spp. (Gopi and Setty, 2010) (liver ailments), Gymnema sylvestre (Leach, 2007), Syzygium cumini (Helmstadter, 2008), Senna auriculata (Gupta et al., 2010) (diabetes), Euphorbia hirta (Galvez et al., 1993) (antidiarrheal), Musa
4.4. Perception and dissemination of knowledge An indigenous person looks at the forest with innumerable memories, associations, and anecdotes. Such aspects of phytodiversity are invisible and inaudible to most of us (Jain, 2000). Their ways of perceiving, testing and transmitting the knowledge on nature is mainly verbal and unique. In such orally transmitted systems, mnemonic cues (memory-aids) are essential to the viability of knowledge transmission (Shepard, 2002). Although, the doctrine of signatures was considered as pre-scientific, its reinterpretation considered it as a device used for knowledge transmission, especially in pre-literate societies and as an attempt to explain why the plant is useful for a particular ailment. Most of the signatures are post-hoc appellations rather than a priori clues (Bennett, 2007) and a way of understanding and retaining quite complex memories (Donald, 1997). Some of the works published earlier have recorded such type of knowledge transmission in India (Jain, 2000) and other countries (Dafni and Lev, 2002). The plants that are both efficacious and easy to remember are more likely to be maintained in the pharmacopoeia of non-literate societies through time (Shepard, 2002). 5. Conclusion The process of drug discovery has become highly expensive and post-approval and post-marketing withdrawal of drugs is continuing. In such a scenario, reverse pharmacology is considered an attractive option because most of the natural products developed in this way are part of routinely used medicines; thus tolerance and safety of these products are relatively better known than other synthetic chemical entities entering first-in-man studies (Patwardhan and Mashelkar, 2009). Further biomedical research on the medicinal plants mentioned in this study especially those with high number of citations and high Fic values for illness categories might provide some potential leads to fulfill the needs of global health priorities. Acknowledgments We are thankful to the traditional healers in Mayiladumparai block of Theni District for their participation and sharing of their valuable knowledge. We are grateful to the Department of
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AYUSH, Ministry of Health and Family Welfare (Sanction Number: Z.15017/40/2008-E&C) for providing financial support for this study. We are thankful to the reviewers for their suggestions to improve the quality of the manuscript.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.jep.2010.12.027.
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