# Application of Ethnobotanical Indices on the Use of Traditional Medicines against Common Diseases

Authors: Imran Khan; Naser M. AbdElsalam; Hassan Fouad; Akash Tariq; Riaz Ullah; Muhammad Adnan
Journal: Evidence-Based Complementary and Alternative Medicine
 (2014)

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## Abstract

The present study was aimed at documenting the detailed ethnomedicinal knowledge of an unexplored area of Pakistan. Semistructured interviews were taken with 55 informants randomly chosen regarding detailed ethnomedicinal and sociocultural information. The study exposed 67 medicinal plant species used to prepare 110 recipes and the major modes of herbal formulation were decoction and powdering (20% each). The disease categories with the highest Fic values were gastrointestinal and dermatological (0.87 each). The study determined 3 plant species, i.e.,Acacia modestaWall., Caralluma tuberculataR.Br., and Withania somnifera(L.) Dunal with a FL of 100%. DMR results showed that Olea ferruginea(Sol.) Steud. ranked first, Morus albaL. ranked second, and Melia azedarachL. ranked third. Among the 55 informants, the male concentration was high (61%) and most of them were over 40 years old while a leading quantity of respondents (45%) was uneducated. There is a dire need to take necessary steps for the conservation of important medicinal plants by inhibiting overgrazing and providing alternate fuel resources. Young generations should be educated regarding the importance of ethnomedicinal knowledge and plants with high Fic and FL values should be further checked chemically and pharmacologically for future exploration of modern medicine.


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## Body

## 1. Introduction

Medicinal plants offer a real substitute in developing countries for the treatment of human and animal ailments [1]. Ethnomedicine is often the single easily reached and affordable therapy available. The world market for herbal medicines based on traditional knowledge is now estimated at US$ 60 billion [2]. Plant-based traditional medicine plays a key role in the development of novelties in drug discovery [3].Pakistan has a rich medicinal plants history having more than 600 plants being used traditionally for medication [4]. The majority of the medicinal plants are confined to northwest regions of Pakistan due to the presence of Himalayas, Karakoram, Sulaiman, and Hindu Kush mountain ranges [5] that lie in association with Pak-Afghan border. Both countries Pakistan and Afghanistan share almost 2,500 kilometers of boundary, called Durand Line, which was demarcated in 1893 following an agreement between the British Empire and the Afghan king [6]. The Durand Line separatesPashtunethnic group in the Pak-Afghan border areas. Culturally, Pashtuns represent the majority of the populace of Afghanistan and also have significant population in Pakistan. The local language of southeastern Afghanistan and northwestern Pakistan Pashtun ethnic group isPashtu [7]. The majority of the northwest areas of Pakistan living in the proximity to border region are rural in nature with high illiteracy rate and greatly depend on medicinal plants for primary health care and for generating income. In Pakistan, various ethnobotanical studies have been conducted in the different regions [8, 9] (Akhtar et al. [9]; Mussarat et al. [10], Hassan et al. [11]; and Begum et al. [12]). Most of the ethnobotanical studies in Pakistan have documented just the uses of medicinal plants. Almost no studies have been documented on detailed ethnomedicines preparations in the border region villages. The current research is the first effort to provide a thorough overview on the ethnomedicines employed by conventional healers and their detailed appliance in the region. This research will offer baseline data for more comprehensive studies on effectiveness and security of these preparations, as well as the potential applications in the communal health system. Moreover, the region is very rich in medicinal plants due to its conductive climate but this area has never been touched so far. Therefore, it is imperative to document the vegetation and detailed home-grown information of people about medicinal plants of this area before it is lost due to changing cultures. The purpose of this study is to assess traditional medicinal plant knowledge specifically with regard to the traditional healer’s demographic characteristics such as gender, age, and source of income and to document the knowledge and the uses of medicinal plants used by the traditional healers in the Hangu region, Pakistan, to provide baseline data for future pharmacological and phytochemical studies by the application of ethnobotanical indices.


## 2. Material and Methods

### 2.1. Study Area

The present study was conducted in Hangu district located in north of Khyber Pakhtunkhwa, Pakistan, near the border region with Afghanistan (Figure1). Hangu is situated at 33.53 North latitude, 71.06 East longitude, and 858 m above the sea level comprising a total area of 1,097 km2 and total population of 314,529 [13]. The dominant vegetation in the study area isAcacia modesta,Olea ferruginea, Dodonaea viscosa(L.) Jacquin,Acacia nilotica L.,Periploca aphylla Decne., Melia azedarach,andMorus alba. The temperature of the area rises gradually from the month of January to June and then slowly turns down up to December. The summer season is modest and warm but June and July are the hottest months. The mean highest temperature is 8.8°C and mean lowest temperature is 7°C in the months of December and January. This district also produces wheat and maize as major crops. The area is rural in nature and the majority of the population is illiterate and they are also deprived of modern health services; hence the locals rely on medicinal flora of the region for the healthcare and to balance their low earnings as well [14]. The inhabitants mostly rely on timber for fuel purposes due to lack of modern fuel resources [13].Figure 1
Map of the study area.


### 2.2. Data Collection

Field work was carried out from October 2012 to October 2013. Data was collected by making total eight frequent visits to the study area in four different seasons. Total 250 informants were recommended by knowledgeable elders, local authorities, and development agents. Out of 250, we have randomly selected 55 (34 men and 21 women) out of the total identified key informants. The selected informers were local inhabitants of the area aged between 20 and 89 years. Ethnobotanical survey was taken to gather information on traditional plants utilized by the local healers for the treatment of human ailments in the district following standard methods [15, 16]. The survey was done by using proper semistructured interviews and group discussions as well. A checklist of questions was prepared in English language for undertaking interviews and discussions. The questionnaire contained no strict questions and informants were allowed to speak spontaneously and without pressure. Key questions about medicinal plants were on local name of a particular medicinal plant, types of disease treated, mode and method of remedy preparation, parts of the plants used, use of fresh or dry plant parts, use of single or mixture of plants for remedy preparation, mode of administration, and dose requirement. Sociocultural information about informants was also collected during interview. The informants were interviewed in their local languagePashto. Ethically written acceptance was collected from the main office of the district and also from the head person of the village. The purpose of the present study was also explained to each informant in order to remove their hesitation and to encourage them that their knowledge will be a great contribution in the scientific literature.


### 2.3. Specimen Collection and Identification

The reported medicinal plants were collected from natural vegetation and home gardens during the field walks and habits of the plants were listed. The collected voucher specimens were taken to the Herbarium of Kohat University of Science and Technology, Kohat, Pakistan. Specimen identification and confirmation were undertaken by using Flora of Pakistan and taxonomic experts. Specimens with their label were stored at the Herbarium of Kohat University of Science and Technology, Kohat, Pakistan.


### 2.4. Data Organization

The collected ethnobotanical data were entered into Excel spreadsheet 2007 and summarized using graphical statistical methods such as percentages. The habit of the plants was categorized into three categories, that is, herbs, shrubs, and trees. The part used by the healers for the preparation of ethnomedicines was grouped under 11 classes, that is, leaves, whole plant, root, fruit, bark, and so forth. Human ailments treated in the study area were categorized into 18 categories like gastrointestinal, dermatological, skeletomuscular, antidiabetic, and so forth. Route of administration was divided into oral, dermal, and nasal. The basic categorization using questionnaire data regarding informants’ sex, age groups, educational status or literacy rate, and occupation was also carried out.


## 2.1. Study Area

The present study was conducted in Hangu district located in north of Khyber Pakhtunkhwa, Pakistan, near the border region with Afghanistan (Figure1). Hangu is situated at 33.53 North latitude, 71.06 East longitude, and 858 m above the sea level comprising a total area of 1,097 km2 and total population of 314,529 [13]. The dominant vegetation in the study area isAcacia modesta,Olea ferruginea, Dodonaea viscosa(L.) Jacquin,Acacia nilotica L.,Periploca aphylla Decne., Melia azedarach,andMorus alba. The temperature of the area rises gradually from the month of January to June and then slowly turns down up to December. The summer season is modest and warm but June and July are the hottest months. The mean highest temperature is 8.8°C and mean lowest temperature is 7°C in the months of December and January. This district also produces wheat and maize as major crops. The area is rural in nature and the majority of the population is illiterate and they are also deprived of modern health services; hence the locals rely on medicinal flora of the region for the healthcare and to balance their low earnings as well [14]. The inhabitants mostly rely on timber for fuel purposes due to lack of modern fuel resources [13].Figure 1
Map of the study area.


## 2.2. Data Collection

Field work was carried out from October 2012 to October 2013. Data was collected by making total eight frequent visits to the study area in four different seasons. Total 250 informants were recommended by knowledgeable elders, local authorities, and development agents. Out of 250, we have randomly selected 55 (34 men and 21 women) out of the total identified key informants. The selected informers were local inhabitants of the area aged between 20 and 89 years. Ethnobotanical survey was taken to gather information on traditional plants utilized by the local healers for the treatment of human ailments in the district following standard methods [15, 16]. The survey was done by using proper semistructured interviews and group discussions as well. A checklist of questions was prepared in English language for undertaking interviews and discussions. The questionnaire contained no strict questions and informants were allowed to speak spontaneously and without pressure. Key questions about medicinal plants were on local name of a particular medicinal plant, types of disease treated, mode and method of remedy preparation, parts of the plants used, use of fresh or dry plant parts, use of single or mixture of plants for remedy preparation, mode of administration, and dose requirement. Sociocultural information about informants was also collected during interview. The informants were interviewed in their local languagePashto. Ethically written acceptance was collected from the main office of the district and also from the head person of the village. The purpose of the present study was also explained to each informant in order to remove their hesitation and to encourage them that their knowledge will be a great contribution in the scientific literature.


## 2.3. Specimen Collection and Identification

The reported medicinal plants were collected from natural vegetation and home gardens during the field walks and habits of the plants were listed. The collected voucher specimens were taken to the Herbarium of Kohat University of Science and Technology, Kohat, Pakistan. Specimen identification and confirmation were undertaken by using Flora of Pakistan and taxonomic experts. Specimens with their label were stored at the Herbarium of Kohat University of Science and Technology, Kohat, Pakistan.


## 2.4. Data Organization

The collected ethnobotanical data were entered into Excel spreadsheet 2007 and summarized using graphical statistical methods such as percentages. The habit of the plants was categorized into three categories, that is, herbs, shrubs, and trees. The part used by the healers for the preparation of ethnomedicines was grouped under 11 classes, that is, leaves, whole plant, root, fruit, bark, and so forth. Human ailments treated in the study area were categorized into 18 categories like gastrointestinal, dermatological, skeletomuscular, antidiabetic, and so forth. Route of administration was divided into oral, dermal, and nasal. The basic categorization using questionnaire data regarding informants’ sex, age groups, educational status or literacy rate, and occupation was also carried out.


## 3. Data Analyses

### 3.1. Informant Consensus Factor (Fic)

For the analysis of the general use of plants, factor informant consensus (Fic) was used to highlight plants of particular cultural relevance and agreement in the use of plants. Informants’ consensus within a community and between cultural groups indicates which plants are widely used and thus aids in the selection of plants for pharmacological and phytochemical studies [17]. In order to use this tool, illnesses were classified into categories, as plants with high Fic are likely to be more pharmacologically efficient as compared to plants with low Fic [18]. Fic values lie between “0.00 and 1.00”. Fic values are always greater when single or few plants are documented to be used by large number of respondents to cure a specific disease, while low Fic values give an indication that informants do not agree over which plant to use [19, 20].The Fic can be calculated using the formula as follows:(1)
Fic
=
nur
-
nt
nur
-
1
,
where Fic = informants consensus factor, nur = number of use citation in each category, and nt = number of species used.


### 3.2. Fidelity Level (FL)

Fidelity level is useful for identifying the key informants’ most preferred species used for treating certain ailments. The medicinal plants that are widely used by the local people have higher FL values than those that are less popular. Fidelity level shows the percentage of informants claiming the use of a certain plant species for the same major purpose. This is designed to quantify the importance of the species for a given purpose. Before calculating the values of FL all of the ailments that were reported are grouped into major classes [21]. FL value was estimated using the formula FL
=
Ip
/
Iu
×
100, where Ip is the number of respondents who reported the utilization of medicinal plants for a specific main ailment and Iu is the total number of respondents who mentioned the same plant for any ailment [22]. It is assumed that those medicinal plants which are plants that are used in some recurring manner for the same disease category are more likely to be biologically active [18].


### 3.3. Direct Matrix Ranking (DMR)

DMR [15, 16] was used to compare the use diversity of given plant species based on the data collected from the respondents. Total eight informants were selected for the collection of DMR data. Selected informants were asked to assign use values (5 = best, 4 = very good, 3 = good, 2 = less used, 1 = least used, and 0 = not used) to each species. The values (average scores) given to each medicinal plant were summed up and ranked.


## 3.1. Informant Consensus Factor (Fic)

For the analysis of the general use of plants, factor informant consensus (Fic) was used to highlight plants of particular cultural relevance and agreement in the use of plants. Informants’ consensus within a community and between cultural groups indicates which plants are widely used and thus aids in the selection of plants for pharmacological and phytochemical studies [17]. In order to use this tool, illnesses were classified into categories, as plants with high Fic are likely to be more pharmacologically efficient as compared to plants with low Fic [18]. Fic values lie between “0.00 and 1.00”. Fic values are always greater when single or few plants are documented to be used by large number of respondents to cure a specific disease, while low Fic values give an indication that informants do not agree over which plant to use [19, 20].The Fic can be calculated using the formula as follows:(1)
Fic
=
nur
-
nt
nur
-
1
,
where Fic = informants consensus factor, nur = number of use citation in each category, and nt = number of species used.


## 3.2. Fidelity Level (FL)

Fidelity level is useful for identifying the key informants’ most preferred species used for treating certain ailments. The medicinal plants that are widely used by the local people have higher FL values than those that are less popular. Fidelity level shows the percentage of informants claiming the use of a certain plant species for the same major purpose. This is designed to quantify the importance of the species for a given purpose. Before calculating the values of FL all of the ailments that were reported are grouped into major classes [21]. FL value was estimated using the formula FL
=
Ip
/
Iu
×
100, where Ip is the number of respondents who reported the utilization of medicinal plants for a specific main ailment and Iu is the total number of respondents who mentioned the same plant for any ailment [22]. It is assumed that those medicinal plants which are plants that are used in some recurring manner for the same disease category are more likely to be biologically active [18].


## 3.3. Direct Matrix Ranking (DMR)

DMR [15, 16] was used to compare the use diversity of given plant species based on the data collected from the respondents. Total eight informants were selected for the collection of DMR data. Selected informants were asked to assign use values (5 = best, 4 = very good, 3 = good, 2 = less used, 1 = least used, and 0 = not used) to each species. The values (average scores) given to each medicinal plant were summed up and ranked.


## 4. Result and Discussion

### 4.1. Medicinal Plants Reported

The study revealed 67 medicinal plant species belonging to 55 genera and 39 families consisting of 65 angiosperms and 2 gymnosperms in Hangu district (Table1). The investigated region has a rich diversity of medicinal plants and provides a conductive habitat and ideal climatic conditions for their growth as shown by the presence of 67 medicinal plant species. The majority of the medicinal plants reported were herbs (43%) followed by shrubs (30%) and trees (27%). The high usage of herbs in the study area could be an indication of their abundance and it might also be due to the fact that they are easily accessible near household and might have high effectiveness in the treatment of ailments in comparison to other growth forms [23]. The common use of herbs for medicinal purposes is also reported from other parts of the world [24, 25]. The dominant families in the study area were Asteraceae and Solanaceae represented by the highest number of species (4 species each, 6%) followed by Euphorbiaceae, Moraceae, Oleaceae, and Lamiaceae (3 species each, 4.47%). Other families with low number represented by 2 species each Amaranthaceae, Acanthaceae, Alliaceae, Poaceae, Papilionaceae, Zygophyllaceae, Arecaceae, and Rhamnaceae, while the remaining 22 families had only single species representation. The wider utilization of species from dominant families like Asteraceae and Solanaceae might relate to the presence of effective bioactive ingredients against ailments [26]. Our results are in line with other ethnomedicinal studies conducted in other regions of Pakistan [9, 27] where traditional healers mostly use Solanaceae and Asteraceae members for the preparation of ethnomedicines.Table 1
Medicinal plants and their preparation methods and administration.
Scientific names
Local names
Families
Habit
Part used
Medicinal uses
Herbal formulation
Administration
Dosage
Acacia modestaWall.
Palosa
Mimosaceae
Tree
Gum, leaves
Backache
Gum and powder of fresh leaves ofAcacia modesta are mixed with wheat flour and desi ghee and make Halwa that is used for backache.
Oral
As needed
Acacia nilotica(L.) Delile
Kikar
Mimosaceae
Tree
Whole plant
Narcotic
Extraction of fresh root and leaves are taken as alcohol (Sharab).
Oral
As needed
Aphrodisiac
Four grams of gum is taken as paste with water.
Oral
Once a day
Earache
About 30 flowers are heated in 10 mL mustard oil and filtered.
Through ear
Two to four drops for 5 days
Allium cepaL.
Pyaaz
Alliaceae
Herb
Leaves
Antipyretic
Equal amount of extract of onion bulb and mint are mixed and used against cholera.
Oral
One teaspoon of this mixture is taken per hour for a period as needed.
Skin infection
Poultice of onion bulb is used against abscesses.
Topical
Two times a day for one week
Allium sativumLinn.
Ugga
Alliaceae
Herb
Leaves, roots
Blood disorders
Small pieces ofAllium sativum are chewed to reduce blood pressure.
Oral
Twice a day
Gastrointestinal
The powder of leaves and roots are also used against stomach problems.
Oral
As needed
Aloe barbadensisMill.
Zarpati
Aloeaceae
Herb
Leaves
Veterinary (gastrointestinal)
Two leaves are made spineless and each one is divided lengthwise into 2 or 3 slices. These slices of leaves along with common salt are given to the animals for stomach disorders.
Oral
Three doses after every 48 hours period
Amaranthus  viridis L.
Sarkoomal.
Amaranthaceae
Herb
Leaves
Gastrointestinal
Leaves are crushed with sugar and taken along with black tea for curing constipation.
Oral
Four times a day
Skin infection
Poultice of leaf is prepared along with mustard oil for the treatment of abscesses.
Topical
As needed
Anagallis  arvensis L.
Dhabbar
Primulaceae
Herb
Whole plant
Rheumatism
The whole plant is crushed into powder after drying. Two gm of the powder with 5 gm of wheat flour is mixed for the treatment of rheumatism.
Oral
Once a day for a week
Cannabis  sativa L.
Bhaang
Cannabaceae
Herb
Leaves, flowering tops, and seed
Narcotic
The fruit and leaves are used as narcotic, commonly called “Charas.”
Oral
As needed
Veterinary
The decoction of seeds is given to cattle for increasing milk.
Oral
As needed
Caralluma  tuberculataR.Br
Pawany
Asclepiadaceae
Shrub
Whole plant
Antidiabetic and anticancer
Whole plant is dried, powdered, and taken with water. Fresh plant is directly eaten by diabetic patient and is very effective in cancer treatment as well.
Oral
Once a day
Cuscuta  reflexa Roxb.
Chum bud
Cuscutaceae.
Herb
Stem and seeds
Wound
A paste of the plant powder in butter is prepared and is externally applied for wounds.
Topical
As needed
Skin infection
The whole plant is crushed and then boiled in 8 liters of water for an hour. It is filtered and the patient is advised to take a bath with this decoction without using soap for scabies.
Topical
As needed
Carthamus  oxycantha Co.Cr.
Spena zagai
Asteraceae
Herb
Seed oil
Jaundice
Seeds are collected, dried under shade, and ground to obtain powder and taken to treat jaundice.
Oral
1 teaspoon of powder is taken twice a day for 3-4 weeks
Skin infection
Few drops of honey are added in seed powder to make paste. This paste is applied on the face. It is effective to remove white spots of skin.
Topical
As needed
Citrus  sinensis
Malta
Rutaceae
Shrub
Fruit, leaves
Gastrointestinal
Fruit is eaten for reducing constipation.
Oral
2 fruits per day
Cynodon dactylonvar. coursii (A. Camus) J.R. Harlan and de Wet
Wakha
Poaceae
Herb
Whole plant
Wounds
The paste made of fresh leaves is applied on cuts and bleeding wounds.
Topical
As needed
Piles
Same as above
Topical
As needed
Gastrointestinal
Juice of the plant is given in diarrhea.
Oral
Twice a day
Antipyretic
Same as above
Oral
Twice a day
Dalbergia  sissoo DC.
Shawa
Papilionaceae
Tree
Whole plant
Piles
70 gm of young leaves of buds are crushed. One glass of water is added to it and strained. The strained decoction is taken daily.
Oral
Taken daily for 10 days
Jaundice
Same as above
Oral
Taken daily for 10 days
Datura  stramonium L.
Tora torii.
Solanaceae
Herb
Whole plant
Earache
The juice of flower is useful for earache.
Oral
As needed
Narcotic
Seeds and leaves are smoked for their narcotic action.
Oral
As needed
Dicliptera  bupleuroides Nees.
Somni
Acanthaceae
Herb
Whole plant
Skin infection
Poultice is used for scabies.
Topical
Once a day
Digera  muricata (L.) Mart.
Tandola
Amaranthaceae
Herb
Whole plant
Gastrointestinal
Juice is extracted from the whole plants and used as laxative.
Oral
As needed
Dodonaea  viscosa (L.) Jacquin
Zetawoni
Sapindaceae
Shrub
Leaves
Rheumatism
The leaves are warmed and kept on joints to relieve pains.
Topical
Once a day
Eriobotrya japanica (Thunb.) Lindl.
Lokat
Rosaceae
Tree
Fruit
Chest problems
Fruit is taken directly to treat cough.
Oral
As needed
Eucalyptus lanceolatus Dehnh.
Lachi
Myrtaceae
Tree
Whole plant
Gastrointestinal
Leaves and bark are boiled in water. Filtrate and decoction are used for abdominal pains. Fruit is added to green tea and taken as antiemetic.
Oral
Twice a day
Euphorbia helioscopia L.
Katta saarai
Euphorbiaceae
Herb
Leaves
Gastrointestinal
Mature leaves (5 g) are mixed with 3 spoonfuls of sugar to prepare recipe to treat constipation
Oral
Twice a day
Euphorbia hirta L.
Chapa tray.
Euphorbiaceae
Herb
Whole plant
Diabetes
Leaves juice is taken for diabetes
Oral
As needed
Fagonia indica Burm.f.
Mazgha Kai.
Zygophyllaceae.
Herb
Aerial parts
Blood purifier
Extract of aerial parts is used
Oral
Thrice a day
Skin infection
Same as above
Topical
Thrice a day
Diabetes
Same as above
Oral
Thrice a day
Antipyretic
Half kg of the whole plant is boiled in 2 liters of water; patients with hepatitis are advised to take bath with this decoction.
Topical
Thrice a day
Ficus carica L.
Inzeer
Moraceae
Tree
Fruit
Piles
Two to four fruits are soaked in water or milk at night and used in the morning on empty stomach.
Oral
Daily for 10 days
Ficus elastica Roxb. ex Hornem.
Rubber Plant
Moraceae
Tree
Leaves, Bark
Antipyretic
Leaves and bark are crushed and taken along honey in small quantity to reduce fever.
Oral
Once a day
Ficus religiosa L.
Peppal
Moraceae
Tree
Whole plant
Vomiting
Decoction of bark is used.
Oral
As needed
Foeniculum vulgare Mill.
Soonphf
Umbelliferae
Herb
Seeds and roots
Gastrointestinal
Take sonf with white zeera, grind it, and use after meal; it is good to remove ulcer and stomach pain
Oral
As needed
Fumaria indica (Hausskn.) Pugsley
Khatee soii.
Fumariaceae
Herb
Aerial parts
Blood purification
Two kg of aerial parts is dried under shade and crushed to obtain powder; 2-3 gm powder with one glass of water is taken.
Oral
Twice a day for one week
Jaundice
Same as above
Oral
Twice a day for one week
Gastrointestinal
Juice of fresh parts is used as laxative.
Oral
Once a day for four days
Antipyretic
Juice of fresh parts is used to reduce fever.
Oral
Once a day for two days
Jasminum humile f.kensuense
Zeet chumbeli
Oleaceae
Shrub
Flower, root, and latex.
Skin infection
Flowers and roots are boiled to make paste and rub on skin for treating pimples.
Topical
Twice a day for one week
Jasminum officinale L.
Chumbeli
Oleaceae
Shrub
Whole plant.
Gastrointestinal
Decoction of leaves and roots are prepared and used as anthelmintic.
Oral
Once a day
Kidney problems
Crushed leaves are mixed with flour and taken along water to treat kidney stones.
Oral
Twice a day for one month
Justicia adhatoda L
Shna Baza
Acanthaceae
Shrub
Leaves
Diabetes
Half kg of fresh leaves of this plant is extracted with 500 mL water and used against diabetes.
Oral
10 mL of extract is used twice a day
Blood purification
Same as above
Oral
10 mL of extract is used twice a day
Chest infection
Leaves and flowers are plucked, dried under shade, ground to obtain powder; 50 gm of this powder is mixed in 15 mL of honey.
Oral
Half teaspoon twice a day for 15 days
Skin infection
Half kg leaves are boiled in 4 liters of water and decoction is used.
Oral
Twice a day
Lathyrus aphaca L.
Jee Wareen
Papilionaceae
Herb
Seed and flower
Skin infection
Decoction is used for skin problems.
Topical
As needed
Malva neglecta Wallr.
Panderak
Malvaceae
Herb
Whole plant
Kidney problems
Roots are taken and boiled in 2 glasses of water and after boiling when 1 glass of water remains, it is taken for kidney stones.
Oral
Once a day for 40 days
Melia azedarach L.
Tora Draka
Meliaceae
Tree
Whole plant
Diabetes
Powder of seeds is used.
Oral
As needed
Gastrointestinal
Fruit is ground and its juice is mixed with oil and taken as anthelmintic.
Oral
As needed
Mentha arvensis L.
Podeena.
Lamiaceae.
Herb
Leaves
Gastrointestinal
70 gm dried leaves of wild mint and 30–40 gm of bishops’ weed are ground together and 10–12 gm of common salt is also added. It is used for gas problems and stomach pain.
Oral
Thrice a day after meal
Vomiting
Tea of dried leaves is taken to stop vomiting.
Oral
As needed
Mentha longifolia L.
Venalai
Lamiaceae
Herb
Leaves
Gastrointestinal
Decoction of leaves is used as carminative.
Oral
As needed
Monotheca buxifolia (Falc.) A. DC.
Gorgola
Sapotaceae
Shrub
Fruit, stem
Skin infection
Poultice is used against skin infection.
Topical
As needed
Morus alba L.
Toot
Moraceae
Tree
Fruit, leaves
Gastrointestinal
Crushed leaves are taken along honey to treat diarrhea.
Oral
Twice a day
Morus nigra L.
Tor Toot
Moraceae
Tree
Fruit, leaves
Kidney problems
Fruit is directly eaten as diuretic.
Oral
Twice a day
Nannorrhops ritchiana. (Griff.) Aitch.
Mazzari
Arecaceae/Palmae
Shrub
Leaves
Gastrointestinal
Crushed leaves are used as carminative.
Oral
As needed
Veterinary
Fresh leaves are given to animals as purgative.
Oral
As needed
Nerium oleander L.
Gand derai
Apocynaceae
Shrub
Leaves
Dental painWound
The fresh leaves are washed and crushed, and then 3 cups of water are added. The filtrate is given to the patients suffering from dental pain.
Oral
Twice a day for 5 days
Poultice of leaves is applied externally to reduce swelling.
Topical
Twice a day
Olea ferruginea (Sol.) Steud.
Kawwaan
Oleaceae.
Tree
Fruit, leaves,seeds, and bark
Dental
Decoction is used for toothache.
Oral
The decoction of fresh leaves is kept in the mouth at night till recovery.
Rheumatism
The oil extracted from the fruits is used as massage in the treatment of rheumatism.
Topical
As needed
Skeletomuscular
Same as above
Topical
As needed
Otostegia limbata Benth.
Spin azghai
Lamiaceae
Shrub
Whole plant
Throat infection
50 gm fresh leaves are ground and 3-4 teaspoons of water are added to it. This mixture is filtered through a cloth and is given to the patient suffering from mouth gums and throat pains.
Oral
As needed
Wound
Crushed leaves are applied for curing of wounds.
Topical
Once a day
Oxalis corniculata L.
Tokee pi.
Oxalidaceae
Herb
Leaves, root
Gastrointestinal
Juice of leaves and roots are used against stomach problem.
Oral
As needed
Peganum harmalaL.
Spin nali
Zygophyllaceae
Herb
Seeds
Spiritual
The smoke from burning seeds and leaves is believed to be devil repellent and also used as protection against evil eyes.
Periploca aphylla Decne.
Barada
Periplocaceae
Shrub
Stem, bark, and latex.
Gastrointestinal
Branches and flower are dried under shade, ground to obtain powder, and taken along water for constipation and stomach ulcer.
Oral
2–4 gm of is powder twice a day
Phoenix dactylifera L.
Khajoor
Arecaceae
Tree
Fruit, leaves
Gastrointestinal
Take four dried khobani and three khajoor  and keep it in milk and boil it. After cooling take it on an empty stomach with 1 teaspoon of isapagul; it is good for controlling constipation.
Oral
As needed
Sex power
Same as above
Oral
As needed
Pinus roxburghii Sarg.
Nakthar
Pinaceae
Tree
All aerial
Dental
Juice is extracted from fresh leaves and bark by grinding. This is mixed with water and  taken for toothache.
Oral
Twice a day before meal and at bed time
Gastrointestinal
Similarly, the bark and leaves ofPinus are dried and crushed, and then the powder is dissolved in cold water and taken for diarrhea.
Oral
Twice a day before meal and at bed time
Skin infection
Leaves of the plant are boiled and the extract is obtained and taken before meal as remedy for scabies.
Oral
As needed
Pistacia chinensis Bunge.
Shenai
Tree
Whole plant
Gastrointestinal
Powdered galls fried with ghee are given internally in dysentery.
Oral
Once a day
Skin infections
The stem gum is added to the mustard oil, warmed, and mixed. The prepared poultice is then applied to the ruptured heels at night.
Topical
At night for once
Plantago lanceolata L.
Gwayo zhabe
Plantaginaceae
Herb
Whole plant
Dental
Leaves are crushed and kept in mouth to relieve toothache.
Oral
As needed
Gastrointestinal
Seeds and fruits are drunk as purgative and laxative.
Oral
As needed
Skin infections
Fresh leaves are crushed for athlete’s foot.
Topical
As needed
Plantanus orientalis L.
Chenar
Platanaceae
Tree
Whole plant
Gastrointestinal
The peel of the fruit is dried, soaked, and ground. The powder so formed, called “Narsaway,” is mixed in small quantity in a cup of curd and is used for dysentery.
Oral
Twice in a day till recovery for the treatment
Punica granatum L.
Anar
Punicaceae
Shrub
Fruit, bark
Gastrointestinal
The fruit pericarp is dried, powdered, mixed with sugar, and used for diarrhea and dysentery.
Oral
As needed
Chest infections
The fruit pericarp is mixed with tea and is given for whooping cough.
Oral
As needed
Blood purifier
Fruit is directly eaten.
Oral
As needed
Rumex dentatus L.
Reen zakai
Polygonaceae
Herb
Leaves
Sex enhancer
Decoction of leaves is used.
Oral
Once at night
Skeletomuscular
Same as above
Oral
As needed
Ricinus communis L.
Raanda
Euphorbiaceae
Shrub
Seeds, leaf, bark,and root.
Gastrointestinal
The small quantity of oil is rubbed on the abdomen, which is slowly and gradually absorbed through sweat glands to release constipation.
Topical
Twice a day for one day
Sageretia thea (Osbeck) M.C. Johnst.
Mamoti
Rhamnaceae
Shrub
Fruit, roots
Jaundice
The extraction of roots is used as cooling agent in jaundice.
Oral
Once a day
Saccharum spontaneum L.
Shaat
Poaceae
Herb
Whole plant
Chest infection
Juice of whole plants is mixed with milk for the treatment of cough.
Oral
Twice a day for two days
Solanum incanum L.
Tarkha Mowtngee
Solanaceae
Shrub
Leaves and roots
Kidney problems
Decoction of leaves and roots are used to break kidney stones.
Oral
As needed
Solanum villosum Miller.
Koot soab
Solanaceae
Herb
Whole plant
Kidney problems
Decoction of leaves and roots are used to break kidney stones.
Oral
As needed
Sonchus arvensis L.
Kroo Konai
Asteraceae
Herb
Whole plant
Wounds
The whole plant is crushed to form a paste. The paste is applied as a poultice on wounds and boils.
Topical
As needed
Silybummarianum (L.)
Azghai
Asteraceae
Herb
Leaves, seeds, and flowers head
AntipyreticJaundice Liver problems
Seeds are collected, dried under shade, and roasted in vegetable oil. Roasted seeds are ground to obtain powder. This is used to treat hepatitis.
Oral
Half teaspoon of this powder is taken thrice a day for a month
Same as above
Oral
Same as above
Same as above
Oral
Same as above
Taraxacum officinale F.H. Wigg.
Asteraceae
Herb
Leaves, root
Jaundice
20–30 gm dried aerial parts are boiled in 1 liter of water for 15–20 min to which 15–20 gm sugar is added. This decoction is filtered and used against jaundice.
Oral
Half cup is given twice a day
Diabetes
Half kg dried aerial parts are boiled in 2 liters water and decoction is filtered and used for diabetes.
Oral
One cup of this decoction is taken twice a day
Terminalia arjuna L.
Combretaceae
Tree
Bark, fruits, and leaves
Cardiovascular
Fruits and leaves are ground to make powder and mix with essential additives.
Oral
Once a day
Vitex negundo L.
Marmandi
Verbenaceae
Shrub
Leaves, root, stem, and seeds
Gastrointestinal
60 gm dried seeds of this plant, 30 gm Bishop’s weed, and 2-3 teaspoon of common salt are ground together to powder.
Oral
As needed
Antipyretic
Same as above
Oral
As needed
Jaundice
The decoction of leaves is used for jaundice.
Oral
As needed
Kidney problem
The seeds are ground to obtain powder and are taken with water for kidney stone.
Oral
Half spoon once a day
Withania somnifera (L.) Dunal
Kapyanga
Solanaceae
Herb
Leaves, roots, and seeds
Kidney problems
The decoction of leaves is taken to break kidney stones.
Oral
As needed
Ziziphus mauritiana var.abyssinica(Hochst. ex A. Rich.) Fiori
Bera
Rhamnaceae
Tree
Fruit, root, and leaves
Gastrointestinal
The decoction of fruit and bark is taken with a cup of milk to treat constipation and dysentery.
Oral
As needed
Ziziphus nummularia (Burm. f.) Wight and Arn.
Karkata
Rhamnaceae
Shrub
Fruit, leaves
Gastrointestinal
Powder of fruits and leaves are used to treat constipation.
Oral
Thrice a day for 2 days


### 4.2. Common Ailments in the Study Area

Traditional healers use 67 medicinal plants for the treatment of a variety of disorders in the studied region. These were grouped into 18 major disease categories like gastrointestinal, dermatological, antipyretic, blood disorders, and so forth. The natives of the region use total 25 plant species for gastrointestinal disorders followed by 13 for dermatological infections. The results are in agreement with other studies conducted in other parts of Pakistan and other countries [28, 29]. The use of a large number of medicinal plants for the treatment of gastrointestinal and dermatological ailments in the region could be due to the high occurrence of these problems in the study area due to bad hygiene, fuel wood smoke inside houses, and other factors like water and air pollution [30]. Informant consensus results have also shown a high degree of consensus for gastrointestinal and dermatological (0.87 each) ailments, which were followed by blood disorder like diabetes (0.84) (Table 2). The highest plant use citation was for gastrointestinal (200) followed by dermatological ailments (100). High Fic value gives an indication that these diseases are more prevalent in the Hangu region that might be due to the poor socioeconomic and sanitary conditions of the people. According to Heinrich et al. [19], high Fic values are very useful in the selection of specific plants for further search of bioactive compounds. The medicinal plants that are widely used by the local people have higher FL values than those that are less popular. The present study revealed 20 medicinal plants having high FL value. FL values in this study varied from 1.0% to 100%. The study determined 3 plant species (Acacia modesta,Caralluma tuberculata, andWithania somnifera) with a FL of 100% followed by 7 (Allium sativa L.,Mentha arvensis L.,Mentha longifolia L.,Cannabis sativaL.,Punica granatumL.,Morus alba, andMorus nigra L.) species with more than 90% and less than 100%, which might be taken as a signal of the excellent curative potential of the plants (Table 3). All these plants that reported higher FL values are not only being frequently used in study region but also in other regions of the Pakistan [8, 31]. These plants possess different phytochemicals responsible for their therapeutic actions.Withania somnifera contains compound withanolides, which are believed to account for its extraordinary medicinal properties [32].Caralluma tuberculata contains pregnane glycosides, flavones glycosides, and other phytochemical responsible for its antidiabetic and anticancer activities [33]. It is understood that plants used in recurring manner are more phytochemically active [16]. High FL value plants might be selected for further chemical screening to investigate the bioactive compounds responsible for their high curative potential [34, 35].Table 2
Fic values of traditional medicinal plants for treating human ailments in district Hangu.
S. Number
Disease categories
Nur
Nt
Fic
1
Gastrointestinal
200
25
0.87
2
Dermatological
100
13
0.87
3
Skeletomuscular
7
2
0.83
4
Blood disorders
58
10
0.84
5
Chest infections
24
7
0.73
6
Jaundice
14
7
0.53
7
Ear nose throat problems
12
3
0.81
8
Antipyretic
32
7
0.80
9
Narcotic
3
2
0.54
10
Sex power
8
3
0.71
11
Kidney problems
22
7
0.71
12
Wounds
3
2
0.54
13
Rheumatism
9
3
0.75
14
Veterinary
9
3
0.75
15
Dental
12
4
0.71
16
Piles
9
3
0.75
17
Liver problems
7
1
1
18
Cardiovascular
9
1
1Table 3
Fidelity level value of medicinal plants commonly reported against a given ailment.
Number
Medicinal plants
Ailments
lp
lu
FL value %
01
Acacia modesta
Skeletomuscular
19
19
100
02
Caralluma tuberculata
Antidiabetic
19
19
100
03
Withania somnifera
Gastrointestinal
26
26
100
04
Allium sativum
Blood pressure
18
19
94.7
05
Mentha arvensis
Gastrointestinal
23
25
92
06
Mentha longifolia
Gastrointestinal
23
25
92
07
Cannabis sativa
Narcotic
11
12
91.6
08
Punica granatum
Blood purifier
21
23
91.3
09
Morus alba
Respiratory tract
19
21
90.4
10
Morus nigra
Respiratory tract
19
21
90.4
11
Oxalis corniculata
Gastrointestinal
17
19
89.4
12
Fagonia indica
Dermatological
17
19
89.4
13
Fagonia indica
Blood purifier
26
30
86.6
14
Ricinus communis
Pregnancy
06
08
75
15
Olea ferruginea
Dermatological
12
16
75
16
Olea ferruginea
Sore throat
11
15
73.3
17
Justicia adhatoda
Skeletomuscular
07
10
70
18
Cuscuta reflexa
Dermatological
11
16
68.7
19
Ziziphus nummularia
Antidiabetic
06
10
60
20
Sageretia thea
Antidiabetic
08
14
57.1


### 4.3. Ethnomedicinal Preparations

Traditional healers mostly use leaves (40%) of the plants followed by whole plant (28%) and fruits (19%) for the preparation of different ethnomedicines. The current investigation showed (Figure2) that leaves (40%) are the most collected plant parts for medicinal purposes. This might be due to easy availability and containing high amount of chemicals and could be easily extracted and used in different forms but it needs biochemical analysis and pharmaceutical screening to cross-check the local information. Use of leaves of plants does not cause damaging effect on the plant life cycle as compared with other parts like roots and flower, and so forth. Due to good rainfall conditions about eight months in the year, the leaves remain green and abundant for most of the months. Our findings of the frequent use of green leaves in the preparation of remedies corroborate the results of [36, 37]. Traditional healers are involved in preparation of 110 recipes preparation and the major modes of ethnomedicines preparation in the studied region were decoction (20%), powdering (20%), crushing (12%), extracting juice (10%), and so forth (Figure 3). Decoction and grinding of medicinal plants for the preparation of ethnomedicines could be due to their high effectiveness for the curing of various ailments. According to Deeba [38], decoction, grinding or crushing, and boiling methods are the most commonly followed methods for the extraction of active compounds. Monotherapy preparations using single medicinal plant were found to be more abundant in comparison with herbal concoction that was prepared by mixing two or three species; for example, healers take equal amount of extract of onion bulb and mint and mix them for the treatment of cholera. Another example is taking 70 gm dried leaves of wild mint and 30–40 g of “bishops” weed and grinding them together and 10–12 gm of common salt is also added to them and taken for the treatment of gastric problem and stomach pain. The use of mixture of plants has recently been shown to increase the effectiveness of the herbal medicine [39]. Out of total 110 ethnomedicines, 91% were prepared by using fresh plant materials, whereas 9% were prepared using dried parts (Table 1). The high usage of freshly prepared ethnomedicines is an indication of the high abundance of medicinal plants in the surrounding areas to be harvested anytime. These findings are in line with other studies conducted in other areas [40, 41]. The other reason behind the repeated use of fresh plant material could be due to the fact that the drying process contributes to the loss of volatile oil and sometimes due to the fact that high temperature protein becomes denature. Higher use of fresh plant material on the other hand is not a sustainable practice as it may threaten the plants due to recurrent harvesting.Figure 2
Plant parts used for remedy preparation.Figure 3
Methods of preparation of ethnomedicines.


### 4.4. Route of Administration and Dosage

The current survey revealed that most of the plant remedies are taken orally and topically in the investigated region while only single recipe is taken through ear (Table1). As mentioned earlier, gastrointestinal and skin problems are common in the region and that might be the reason why the majority of the plants are being used orally and topically while some of the plants are being used through ears. Ethnomedicines are taken along different types of additives generally called vectors like honey, salt, sugar, milk, desi ghee, and wheat flour for the purpose of increasing flavor and to reduce the astringent taste of the remedies. This means that since traditional medicines could have sour or bitter tastes in most cases, the additives reduce such tastes and may even improve the efficacy of the medicine. The measurements used to determine the dosages are not standardized and depend on the age and physical appearance of the patient, sociocultural explanation of the illness, diagnosis, and experience of individual herbalist [42]. Mostly the treatment of the patient is completed within a single day or couple of days. When the patients did not show any indication of improvement from their sickness following treatment completion, they were recommended to modern health centres in urban area for further examination by the physician.


### 4.5. Multipurpose Medicinal Plants and Threats to Their Extinction

The results of the DMR implementation on multipurpose medicinal plants enabled us to recognize which of the multipurpose plants are more under stress in the area and the causes that threaten the plant (Table4). Accordingly,Olea ferruginea ranked first,Morus alba ranked second,Melia azedarch ranked third, andAcacia modesta ranked fourth whileAcacia nilotica ranked fifth. These multipurpose species are basically trees and therefore these species are facing great pressures as the local people are unsustainably harvesting these species for a variety of purposes. The factors responsible for the declining of these species abundance in the area were their overharvesting for agricultural tool, construction, fodder, and fire wood purposes. Beside these major threats, locals of the region also use these plants for handicrafts manufacturing. Free grazing is the common practice in the area. Before the commencement of winter, the grasses are harvested, dried, and put into a stake. The harvesting is done collectively, and then during the bare and cold months of winter, these are fed to the domestic animals. Fuel consumption per home in the studied area is often considered more than the consumption on feeding and other requirements because of severe winters. Thus, the results require urgent conservation strategies to save the declining population of multipurpose plant species in the study region. References [43, 44] have also stated the identical pattern of maximum exploitation of multipurpose medicinal plants for uses other than their traditional medicinal importance in southeastern Ethiopia. Traditional healers mostly use the whole plant of these multipurpose species or individual roots (Table 1) of some species for the preparation of ethnomedicinal recipes and this is an unsustainable practice as compared to leaves. Therefore, there is a dire need to take necessary steps for the conservation of these species before their extinction.Table 4
DMR score of fifteen key informants for eleven medicinal plants species with additional uses besides medicinal value.
Usediversity
A. modesta
P. chinensis
D. viscosa
D. sissoo
M. azedarach
M. alba nigra
O. ferruginea
F. religiosa
P. roxburghii
A. nilotica
Z.  mauritiana
Total
Rank
Agriculturaltool
2
0
3
0
4
5
5
0
1
5
0
25
4
Construction
0
4
0
5
5
5
5
5
4
3
2
38
3
Fodder
5
3
0
0
0
5
3
3
0
0
4
23
5
Fire wood
5
3
5
3
5
4
5
4
3
5
3
45
1
Medicine
5
3
3
3
4
5
5
2
3
3
3
39
2
Total
17
13
11
11
18
20
23
14
11
16
12
Rank
4
7
9
9
3
2
1
6
9
5
8
Based on use criteria (5 = best; 4 = very good; 3 = good; 2 = less used; 1 = least used; and 0 = no value).


### 4.6. Indigenous Knowledge Associated with Gender, Age, and Socioeconomic Status of the People

Among the 55 informants, 34 (61.81%) were male and 21 (38.18%) were female (Table5). It is witnessed that males had better knowledge regarding ethnomedicines than females. The reason behind that men have well indigenous knowledge than women might be due to the fact that the men are usually favoured in the shift of the knowledge; however, in many cultures women are responsible for the family’s health. The highest number of informants aged above 40 years. The result shows that traditional knowledge is prevalent among the community members; however, it is under threat of transferring to the younger generation to come. The decreasing rate of transfer of indigenous knowledge might be due to the lack of interest among the younger generation to learn and practice it, which might be attributed to the ever increasing influence of modernization [8]. Almost half of the respondents interviewed were illiterate (45.45%), whilst most of those with an education had merely primary (29.09%) which reflect the unavailability of standard educational institution in the area (Table 5). Literate people in the study area were found to have less knowledge of medicinal plants as compared to illiterate ones as the former are more likely to be exposed to modernization as also revealed by studies conducted elsewhere [8, 45, 46]. The inhabitants of the study area are not very well off due to less literacy rate and therefore they are heavily dependent on medicinal plants for a variety of purposes in order to compensate their income.Table 5
Gender, age group and literacy level frequencies, and occupation of the interviewed people in the region.
Total
Percentage
Gender
Male
34
61.81
Female
21
38.18
Age groups
20–29
2
3.63
30–39
3
5.45
40–49
7
12.72
50–59
7
12.72
60–69
15
27.27
70–79
12
21.81
80–89
9
16.3
Educational attainment
Illiterate
25
45.45
Primary
16
29.09
Middle
10
18.18
Secondary
2
3.63
University
2
3.63
Occupation
Females
House wives
19
90.47
Primary teacher
2
9.52
Males
Shopkeepers
10
29.4
Farmers
13
38.2
Labours
6
17.6
Primary teachers
5
14.7


## 4.1. Medicinal Plants Reported

The study revealed 67 medicinal plant species belonging to 55 genera and 39 families consisting of 65 angiosperms and 2 gymnosperms in Hangu district (Table1). The investigated region has a rich diversity of medicinal plants and provides a conductive habitat and ideal climatic conditions for their growth as shown by the presence of 67 medicinal plant species. The majority of the medicinal plants reported were herbs (43%) followed by shrubs (30%) and trees (27%). The high usage of herbs in the study area could be an indication of their abundance and it might also be due to the fact that they are easily accessible near household and might have high effectiveness in the treatment of ailments in comparison to other growth forms [23]. The common use of herbs for medicinal purposes is also reported from other parts of the world [24, 25]. The dominant families in the study area were Asteraceae and Solanaceae represented by the highest number of species (4 species each, 6%) followed by Euphorbiaceae, Moraceae, Oleaceae, and Lamiaceae (3 species each, 4.47%). Other families with low number represented by 2 species each Amaranthaceae, Acanthaceae, Alliaceae, Poaceae, Papilionaceae, Zygophyllaceae, Arecaceae, and Rhamnaceae, while the remaining 22 families had only single species representation. The wider utilization of species from dominant families like Asteraceae and Solanaceae might relate to the presence of effective bioactive ingredients against ailments [26]. Our results are in line with other ethnomedicinal studies conducted in other regions of Pakistan [9, 27] where traditional healers mostly use Solanaceae and Asteraceae members for the preparation of ethnomedicines.Table 1
Medicinal plants and their preparation methods and administration.
Scientific names
Local names
Families
Habit
Part used
Medicinal uses
Herbal formulation
Administration
Dosage
Acacia modestaWall.
Palosa
Mimosaceae
Tree
Gum, leaves
Backache
Gum and powder of fresh leaves ofAcacia modesta are mixed with wheat flour and desi ghee and make Halwa that is used for backache.
Oral
As needed
Acacia nilotica(L.) Delile
Kikar
Mimosaceae
Tree
Whole plant
Narcotic
Extraction of fresh root and leaves are taken as alcohol (Sharab).
Oral
As needed
Aphrodisiac
Four grams of gum is taken as paste with water.
Oral
Once a day
Earache
About 30 flowers are heated in 10 mL mustard oil and filtered.
Through ear
Two to four drops for 5 days
Allium cepaL.
Pyaaz
Alliaceae
Herb
Leaves
Antipyretic
Equal amount of extract of onion bulb and mint are mixed and used against cholera.
Oral
One teaspoon of this mixture is taken per hour for a period as needed.
Skin infection
Poultice of onion bulb is used against abscesses.
Topical
Two times a day for one week
Allium sativumLinn.
Ugga
Alliaceae
Herb
Leaves, roots
Blood disorders
Small pieces ofAllium sativum are chewed to reduce blood pressure.
Oral
Twice a day
Gastrointestinal
The powder of leaves and roots are also used against stomach problems.
Oral
As needed
Aloe barbadensisMill.
Zarpati
Aloeaceae
Herb
Leaves
Veterinary (gastrointestinal)
Two leaves are made spineless and each one is divided lengthwise into 2 or 3 slices. These slices of leaves along with common salt are given to the animals for stomach disorders.
Oral
Three doses after every 48 hours period
Amaranthus  viridis L.
Sarkoomal.
Amaranthaceae
Herb
Leaves
Gastrointestinal
Leaves are crushed with sugar and taken along with black tea for curing constipation.
Oral
Four times a day
Skin infection
Poultice of leaf is prepared along with mustard oil for the treatment of abscesses.
Topical
As needed
Anagallis  arvensis L.
Dhabbar
Primulaceae
Herb
Whole plant
Rheumatism
The whole plant is crushed into powder after drying. Two gm of the powder with 5 gm of wheat flour is mixed for the treatment of rheumatism.
Oral
Once a day for a week
Cannabis  sativa L.
Bhaang
Cannabaceae
Herb
Leaves, flowering tops, and seed
Narcotic
The fruit and leaves are used as narcotic, commonly called “Charas.”
Oral
As needed
Veterinary
The decoction of seeds is given to cattle for increasing milk.
Oral
As needed
Caralluma  tuberculataR.Br
Pawany
Asclepiadaceae
Shrub
Whole plant
Antidiabetic and anticancer
Whole plant is dried, powdered, and taken with water. Fresh plant is directly eaten by diabetic patient and is very effective in cancer treatment as well.
Oral
Once a day
Cuscuta  reflexa Roxb.
Chum bud
Cuscutaceae.
Herb
Stem and seeds
Wound
A paste of the plant powder in butter is prepared and is externally applied for wounds.
Topical
As needed
Skin infection
The whole plant is crushed and then boiled in 8 liters of water for an hour. It is filtered and the patient is advised to take a bath with this decoction without using soap for scabies.
Topical
As needed
Carthamus  oxycantha Co.Cr.
Spena zagai
Asteraceae
Herb
Seed oil
Jaundice
Seeds are collected, dried under shade, and ground to obtain powder and taken to treat jaundice.
Oral
1 teaspoon of powder is taken twice a day for 3-4 weeks
Skin infection
Few drops of honey are added in seed powder to make paste. This paste is applied on the face. It is effective to remove white spots of skin.
Topical
As needed
Citrus  sinensis
Malta
Rutaceae
Shrub
Fruit, leaves
Gastrointestinal
Fruit is eaten for reducing constipation.
Oral
2 fruits per day
Cynodon dactylonvar. coursii (A. Camus) J.R. Harlan and de Wet
Wakha
Poaceae
Herb
Whole plant
Wounds
The paste made of fresh leaves is applied on cuts and bleeding wounds.
Topical
As needed
Piles
Same as above
Topical
As needed
Gastrointestinal
Juice of the plant is given in diarrhea.
Oral
Twice a day
Antipyretic
Same as above
Oral
Twice a day
Dalbergia  sissoo DC.
Shawa
Papilionaceae
Tree
Whole plant
Piles
70 gm of young leaves of buds are crushed. One glass of water is added to it and strained. The strained decoction is taken daily.
Oral
Taken daily for 10 days
Jaundice
Same as above
Oral
Taken daily for 10 days
Datura  stramonium L.
Tora torii.
Solanaceae
Herb
Whole plant
Earache
The juice of flower is useful for earache.
Oral
As needed
Narcotic
Seeds and leaves are smoked for their narcotic action.
Oral
As needed
Dicliptera  bupleuroides Nees.
Somni
Acanthaceae
Herb
Whole plant
Skin infection
Poultice is used for scabies.
Topical
Once a day
Digera  muricata (L.) Mart.
Tandola
Amaranthaceae
Herb
Whole plant
Gastrointestinal
Juice is extracted from the whole plants and used as laxative.
Oral
As needed
Dodonaea  viscosa (L.) Jacquin
Zetawoni
Sapindaceae
Shrub
Leaves
Rheumatism
The leaves are warmed and kept on joints to relieve pains.
Topical
Once a day
Eriobotrya japanica (Thunb.) Lindl.
Lokat
Rosaceae
Tree
Fruit
Chest problems
Fruit is taken directly to treat cough.
Oral
As needed
Eucalyptus lanceolatus Dehnh.
Lachi
Myrtaceae
Tree
Whole plant
Gastrointestinal
Leaves and bark are boiled in water. Filtrate and decoction are used for abdominal pains. Fruit is added to green tea and taken as antiemetic.
Oral
Twice a day
Euphorbia helioscopia L.
Katta saarai
Euphorbiaceae
Herb
Leaves
Gastrointestinal
Mature leaves (5 g) are mixed with 3 spoonfuls of sugar to prepare recipe to treat constipation
Oral
Twice a day
Euphorbia hirta L.
Chapa tray.
Euphorbiaceae
Herb
Whole plant
Diabetes
Leaves juice is taken for diabetes
Oral
As needed
Fagonia indica Burm.f.
Mazgha Kai.
Zygophyllaceae.
Herb
Aerial parts
Blood purifier
Extract of aerial parts is used
Oral
Thrice a day
Skin infection
Same as above
Topical
Thrice a day
Diabetes
Same as above
Oral
Thrice a day
Antipyretic
Half kg of the whole plant is boiled in 2 liters of water; patients with hepatitis are advised to take bath with this decoction.
Topical
Thrice a day
Ficus carica L.
Inzeer
Moraceae
Tree
Fruit
Piles
Two to four fruits are soaked in water or milk at night and used in the morning on empty stomach.
Oral
Daily for 10 days
Ficus elastica Roxb. ex Hornem.
Rubber Plant
Moraceae
Tree
Leaves, Bark
Antipyretic
Leaves and bark are crushed and taken along honey in small quantity to reduce fever.
Oral
Once a day
Ficus religiosa L.
Peppal
Moraceae
Tree
Whole plant
Vomiting
Decoction of bark is used.
Oral
As needed
Foeniculum vulgare Mill.
Soonphf
Umbelliferae
Herb
Seeds and roots
Gastrointestinal
Take sonf with white zeera, grind it, and use after meal; it is good to remove ulcer and stomach pain
Oral
As needed
Fumaria indica (Hausskn.) Pugsley
Khatee soii.
Fumariaceae
Herb
Aerial parts
Blood purification
Two kg of aerial parts is dried under shade and crushed to obtain powder; 2-3 gm powder with one glass of water is taken.
Oral
Twice a day for one week
Jaundice
Same as above
Oral
Twice a day for one week
Gastrointestinal
Juice of fresh parts is used as laxative.
Oral
Once a day for four days
Antipyretic
Juice of fresh parts is used to reduce fever.
Oral
Once a day for two days
Jasminum humile f.kensuense
Zeet chumbeli
Oleaceae
Shrub
Flower, root, and latex.
Skin infection
Flowers and roots are boiled to make paste and rub on skin for treating pimples.
Topical
Twice a day for one week
Jasminum officinale L.
Chumbeli
Oleaceae
Shrub
Whole plant.
Gastrointestinal
Decoction of leaves and roots are prepared and used as anthelmintic.
Oral
Once a day
Kidney problems
Crushed leaves are mixed with flour and taken along water to treat kidney stones.
Oral
Twice a day for one month
Justicia adhatoda L
Shna Baza
Acanthaceae
Shrub
Leaves
Diabetes
Half kg of fresh leaves of this plant is extracted with 500 mL water and used against diabetes.
Oral
10 mL of extract is used twice a day
Blood purification
Same as above
Oral
10 mL of extract is used twice a day
Chest infection
Leaves and flowers are plucked, dried under shade, ground to obtain powder; 50 gm of this powder is mixed in 15 mL of honey.
Oral
Half teaspoon twice a day for 15 days
Skin infection
Half kg leaves are boiled in 4 liters of water and decoction is used.
Oral
Twice a day
Lathyrus aphaca L.
Jee Wareen
Papilionaceae
Herb
Seed and flower
Skin infection
Decoction is used for skin problems.
Topical
As needed
Malva neglecta Wallr.
Panderak
Malvaceae
Herb
Whole plant
Kidney problems
Roots are taken and boiled in 2 glasses of water and after boiling when 1 glass of water remains, it is taken for kidney stones.
Oral
Once a day for 40 days
Melia azedarach L.
Tora Draka
Meliaceae
Tree
Whole plant
Diabetes
Powder of seeds is used.
Oral
As needed
Gastrointestinal
Fruit is ground and its juice is mixed with oil and taken as anthelmintic.
Oral
As needed
Mentha arvensis L.
Podeena.
Lamiaceae.
Herb
Leaves
Gastrointestinal
70 gm dried leaves of wild mint and 30–40 gm of bishops’ weed are ground together and 10–12 gm of common salt is also added. It is used for gas problems and stomach pain.
Oral
Thrice a day after meal
Vomiting
Tea of dried leaves is taken to stop vomiting.
Oral
As needed
Mentha longifolia L.
Venalai
Lamiaceae
Herb
Leaves
Gastrointestinal
Decoction of leaves is used as carminative.
Oral
As needed
Monotheca buxifolia (Falc.) A. DC.
Gorgola
Sapotaceae
Shrub
Fruit, stem
Skin infection
Poultice is used against skin infection.
Topical
As needed
Morus alba L.
Toot
Moraceae
Tree
Fruit, leaves
Gastrointestinal
Crushed leaves are taken along honey to treat diarrhea.
Oral
Twice a day
Morus nigra L.
Tor Toot
Moraceae
Tree
Fruit, leaves
Kidney problems
Fruit is directly eaten as diuretic.
Oral
Twice a day
Nannorrhops ritchiana. (Griff.) Aitch.
Mazzari
Arecaceae/Palmae
Shrub
Leaves
Gastrointestinal
Crushed leaves are used as carminative.
Oral
As needed
Veterinary
Fresh leaves are given to animals as purgative.
Oral
As needed
Nerium oleander L.
Gand derai
Apocynaceae
Shrub
Leaves
Dental painWound
The fresh leaves are washed and crushed, and then 3 cups of water are added. The filtrate is given to the patients suffering from dental pain.
Oral
Twice a day for 5 days
Poultice of leaves is applied externally to reduce swelling.
Topical
Twice a day
Olea ferruginea (Sol.) Steud.
Kawwaan
Oleaceae.
Tree
Fruit, leaves,seeds, and bark
Dental
Decoction is used for toothache.
Oral
The decoction of fresh leaves is kept in the mouth at night till recovery.
Rheumatism
The oil extracted from the fruits is used as massage in the treatment of rheumatism.
Topical
As needed
Skeletomuscular
Same as above
Topical
As needed
Otostegia limbata Benth.
Spin azghai
Lamiaceae
Shrub
Whole plant
Throat infection
50 gm fresh leaves are ground and 3-4 teaspoons of water are added to it. This mixture is filtered through a cloth and is given to the patient suffering from mouth gums and throat pains.
Oral
As needed
Wound
Crushed leaves are applied for curing of wounds.
Topical
Once a day
Oxalis corniculata L.
Tokee pi.
Oxalidaceae
Herb
Leaves, root
Gastrointestinal
Juice of leaves and roots are used against stomach problem.
Oral
As needed
Peganum harmalaL.
Spin nali
Zygophyllaceae
Herb
Seeds
Spiritual
The smoke from burning seeds and leaves is believed to be devil repellent and also used as protection against evil eyes.
Periploca aphylla Decne.
Barada
Periplocaceae
Shrub
Stem, bark, and latex.
Gastrointestinal
Branches and flower are dried under shade, ground to obtain powder, and taken along water for constipation and stomach ulcer.
Oral
2–4 gm of is powder twice a day
Phoenix dactylifera L.
Khajoor
Arecaceae
Tree
Fruit, leaves
Gastrointestinal
Take four dried khobani and three khajoor  and keep it in milk and boil it. After cooling take it on an empty stomach with 1 teaspoon of isapagul; it is good for controlling constipation.
Oral
As needed
Sex power
Same as above
Oral
As needed
Pinus roxburghii Sarg.
Nakthar
Pinaceae
Tree
All aerial
Dental
Juice is extracted from fresh leaves and bark by grinding. This is mixed with water and  taken for toothache.
Oral
Twice a day before meal and at bed time
Gastrointestinal
Similarly, the bark and leaves ofPinus are dried and crushed, and then the powder is dissolved in cold water and taken for diarrhea.
Oral
Twice a day before meal and at bed time
Skin infection
Leaves of the plant are boiled and the extract is obtained and taken before meal as remedy for scabies.
Oral
As needed
Pistacia chinensis Bunge.
Shenai
Tree
Whole plant
Gastrointestinal
Powdered galls fried with ghee are given internally in dysentery.
Oral
Once a day
Skin infections
The stem gum is added to the mustard oil, warmed, and mixed. The prepared poultice is then applied to the ruptured heels at night.
Topical
At night for once
Plantago lanceolata L.
Gwayo zhabe
Plantaginaceae
Herb
Whole plant
Dental
Leaves are crushed and kept in mouth to relieve toothache.
Oral
As needed
Gastrointestinal
Seeds and fruits are drunk as purgative and laxative.
Oral
As needed
Skin infections
Fresh leaves are crushed for athlete’s foot.
Topical
As needed
Plantanus orientalis L.
Chenar
Platanaceae
Tree
Whole plant
Gastrointestinal
The peel of the fruit is dried, soaked, and ground. The powder so formed, called “Narsaway,” is mixed in small quantity in a cup of curd and is used for dysentery.
Oral
Twice in a day till recovery for the treatment
Punica granatum L.
Anar
Punicaceae
Shrub
Fruit, bark
Gastrointestinal
The fruit pericarp is dried, powdered, mixed with sugar, and used for diarrhea and dysentery.
Oral
As needed
Chest infections
The fruit pericarp is mixed with tea and is given for whooping cough.
Oral
As needed
Blood purifier
Fruit is directly eaten.
Oral
As needed
Rumex dentatus L.
Reen zakai
Polygonaceae
Herb
Leaves
Sex enhancer
Decoction of leaves is used.
Oral
Once at night
Skeletomuscular
Same as above
Oral
As needed
Ricinus communis L.
Raanda
Euphorbiaceae
Shrub
Seeds, leaf, bark,and root.
Gastrointestinal
The small quantity of oil is rubbed on the abdomen, which is slowly and gradually absorbed through sweat glands to release constipation.
Topical
Twice a day for one day
Sageretia thea (Osbeck) M.C. Johnst.
Mamoti
Rhamnaceae
Shrub
Fruit, roots
Jaundice
The extraction of roots is used as cooling agent in jaundice.
Oral
Once a day
Saccharum spontaneum L.
Shaat
Poaceae
Herb
Whole plant
Chest infection
Juice of whole plants is mixed with milk for the treatment of cough.
Oral
Twice a day for two days
Solanum incanum L.
Tarkha Mowtngee
Solanaceae
Shrub
Leaves and roots
Kidney problems
Decoction of leaves and roots are used to break kidney stones.
Oral
As needed
Solanum villosum Miller.
Koot soab
Solanaceae
Herb
Whole plant
Kidney problems
Decoction of leaves and roots are used to break kidney stones.
Oral
As needed
Sonchus arvensis L.
Kroo Konai
Asteraceae
Herb
Whole plant
Wounds
The whole plant is crushed to form a paste. The paste is applied as a poultice on wounds and boils.
Topical
As needed
Silybummarianum (L.)
Azghai
Asteraceae
Herb
Leaves, seeds, and flowers head
AntipyreticJaundice Liver problems
Seeds are collected, dried under shade, and roasted in vegetable oil. Roasted seeds are ground to obtain powder. This is used to treat hepatitis.
Oral
Half teaspoon of this powder is taken thrice a day for a month
Same as above
Oral
Same as above
Same as above
Oral
Same as above
Taraxacum officinale F.H. Wigg.
Asteraceae
Herb
Leaves, root
Jaundice
20–30 gm dried aerial parts are boiled in 1 liter of water for 15–20 min to which 15–20 gm sugar is added. This decoction is filtered and used against jaundice.
Oral
Half cup is given twice a day
Diabetes
Half kg dried aerial parts are boiled in 2 liters water and decoction is filtered and used for diabetes.
Oral
One cup of this decoction is taken twice a day
Terminalia arjuna L.
Combretaceae
Tree
Bark, fruits, and leaves
Cardiovascular
Fruits and leaves are ground to make powder and mix with essential additives.
Oral
Once a day
Vitex negundo L.
Marmandi
Verbenaceae
Shrub
Leaves, root, stem, and seeds
Gastrointestinal
60 gm dried seeds of this plant, 30 gm Bishop’s weed, and 2-3 teaspoon of common salt are ground together to powder.
Oral
As needed
Antipyretic
Same as above
Oral
As needed
Jaundice
The decoction of leaves is used for jaundice.
Oral
As needed
Kidney problem
The seeds are ground to obtain powder and are taken with water for kidney stone.
Oral
Half spoon once a day
Withania somnifera (L.) Dunal
Kapyanga
Solanaceae
Herb
Leaves, roots, and seeds
Kidney problems
The decoction of leaves is taken to break kidney stones.
Oral
As needed
Ziziphus mauritiana var.abyssinica(Hochst. ex A. Rich.) Fiori
Bera
Rhamnaceae
Tree
Fruit, root, and leaves
Gastrointestinal
The decoction of fruit and bark is taken with a cup of milk to treat constipation and dysentery.
Oral
As needed
Ziziphus nummularia (Burm. f.) Wight and Arn.
Karkata
Rhamnaceae
Shrub
Fruit, leaves
Gastrointestinal
Powder of fruits and leaves are used to treat constipation.
Oral
Thrice a day for 2 days


## 4.2. Common Ailments in the Study Area

Traditional healers use 67 medicinal plants for the treatment of a variety of disorders in the studied region. These were grouped into 18 major disease categories like gastrointestinal, dermatological, antipyretic, blood disorders, and so forth. The natives of the region use total 25 plant species for gastrointestinal disorders followed by 13 for dermatological infections. The results are in agreement with other studies conducted in other parts of Pakistan and other countries [28, 29]. The use of a large number of medicinal plants for the treatment of gastrointestinal and dermatological ailments in the region could be due to the high occurrence of these problems in the study area due to bad hygiene, fuel wood smoke inside houses, and other factors like water and air pollution [30]. Informant consensus results have also shown a high degree of consensus for gastrointestinal and dermatological (0.87 each) ailments, which were followed by blood disorder like diabetes (0.84) (Table 2). The highest plant use citation was for gastrointestinal (200) followed by dermatological ailments (100). High Fic value gives an indication that these diseases are more prevalent in the Hangu region that might be due to the poor socioeconomic and sanitary conditions of the people. According to Heinrich et al. [19], high Fic values are very useful in the selection of specific plants for further search of bioactive compounds. The medicinal plants that are widely used by the local people have higher FL values than those that are less popular. The present study revealed 20 medicinal plants having high FL value. FL values in this study varied from 1.0% to 100%. The study determined 3 plant species (Acacia modesta,Caralluma tuberculata, andWithania somnifera) with a FL of 100% followed by 7 (Allium sativa L.,Mentha arvensis L.,Mentha longifolia L.,Cannabis sativaL.,Punica granatumL.,Morus alba, andMorus nigra L.) species with more than 90% and less than 100%, which might be taken as a signal of the excellent curative potential of the plants (Table 3). All these plants that reported higher FL values are not only being frequently used in study region but also in other regions of the Pakistan [8, 31]. These plants possess different phytochemicals responsible for their therapeutic actions.Withania somnifera contains compound withanolides, which are believed to account for its extraordinary medicinal properties [32].Caralluma tuberculata contains pregnane glycosides, flavones glycosides, and other phytochemical responsible for its antidiabetic and anticancer activities [33]. It is understood that plants used in recurring manner are more phytochemically active [16]. High FL value plants might be selected for further chemical screening to investigate the bioactive compounds responsible for their high curative potential [34, 35].Table 2
Fic values of traditional medicinal plants for treating human ailments in district Hangu.
S. Number
Disease categories
Nur
Nt
Fic
1
Gastrointestinal
200
25
0.87
2
Dermatological
100
13
0.87
3
Skeletomuscular
7
2
0.83
4
Blood disorders
58
10
0.84
5
Chest infections
24
7
0.73
6
Jaundice
14
7
0.53
7
Ear nose throat problems
12
3
0.81
8
Antipyretic
32
7
0.80
9
Narcotic
3
2
0.54
10
Sex power
8
3
0.71
11
Kidney problems
22
7
0.71
12
Wounds
3
2
0.54
13
Rheumatism
9
3
0.75
14
Veterinary
9
3
0.75
15
Dental
12
4
0.71
16
Piles
9
3
0.75
17
Liver problems
7
1
1
18
Cardiovascular
9
1
1Table 3
Fidelity level value of medicinal plants commonly reported against a given ailment.
Number
Medicinal plants
Ailments
lp
lu
FL value %
01
Acacia modesta
Skeletomuscular
19
19
100
02
Caralluma tuberculata
Antidiabetic
19
19
100
03
Withania somnifera
Gastrointestinal
26
26
100
04
Allium sativum
Blood pressure
18
19
94.7
05
Mentha arvensis
Gastrointestinal
23
25
92
06
Mentha longifolia
Gastrointestinal
23
25
92
07
Cannabis sativa
Narcotic
11
12
91.6
08
Punica granatum
Blood purifier
21
23
91.3
09
Morus alba
Respiratory tract
19
21
90.4
10
Morus nigra
Respiratory tract
19
21
90.4
11
Oxalis corniculata
Gastrointestinal
17
19
89.4
12
Fagonia indica
Dermatological
17
19
89.4
13
Fagonia indica
Blood purifier
26
30
86.6
14
Ricinus communis
Pregnancy
06
08
75
15
Olea ferruginea
Dermatological
12
16
75
16
Olea ferruginea
Sore throat
11
15
73.3
17
Justicia adhatoda
Skeletomuscular
07
10
70
18
Cuscuta reflexa
Dermatological
11
16
68.7
19
Ziziphus nummularia
Antidiabetic
06
10
60
20
Sageretia thea
Antidiabetic
08
14
57.1


## 4.3. Ethnomedicinal Preparations

Traditional healers mostly use leaves (40%) of the plants followed by whole plant (28%) and fruits (19%) for the preparation of different ethnomedicines. The current investigation showed (Figure2) that leaves (40%) are the most collected plant parts for medicinal purposes. This might be due to easy availability and containing high amount of chemicals and could be easily extracted and used in different forms but it needs biochemical analysis and pharmaceutical screening to cross-check the local information. Use of leaves of plants does not cause damaging effect on the plant life cycle as compared with other parts like roots and flower, and so forth. Due to good rainfall conditions about eight months in the year, the leaves remain green and abundant for most of the months. Our findings of the frequent use of green leaves in the preparation of remedies corroborate the results of [36, 37]. Traditional healers are involved in preparation of 110 recipes preparation and the major modes of ethnomedicines preparation in the studied region were decoction (20%), powdering (20%), crushing (12%), extracting juice (10%), and so forth (Figure 3). Decoction and grinding of medicinal plants for the preparation of ethnomedicines could be due to their high effectiveness for the curing of various ailments. According to Deeba [38], decoction, grinding or crushing, and boiling methods are the most commonly followed methods for the extraction of active compounds. Monotherapy preparations using single medicinal plant were found to be more abundant in comparison with herbal concoction that was prepared by mixing two or three species; for example, healers take equal amount of extract of onion bulb and mint and mix them for the treatment of cholera. Another example is taking 70 gm dried leaves of wild mint and 30–40 g of “bishops” weed and grinding them together and 10–12 gm of common salt is also added to them and taken for the treatment of gastric problem and stomach pain. The use of mixture of plants has recently been shown to increase the effectiveness of the herbal medicine [39]. Out of total 110 ethnomedicines, 91% were prepared by using fresh plant materials, whereas 9% were prepared using dried parts (Table 1). The high usage of freshly prepared ethnomedicines is an indication of the high abundance of medicinal plants in the surrounding areas to be harvested anytime. These findings are in line with other studies conducted in other areas [40, 41]. The other reason behind the repeated use of fresh plant material could be due to the fact that the drying process contributes to the loss of volatile oil and sometimes due to the fact that high temperature protein becomes denature. Higher use of fresh plant material on the other hand is not a sustainable practice as it may threaten the plants due to recurrent harvesting.Figure 2
Plant parts used for remedy preparation.Figure 3
Methods of preparation of ethnomedicines.


## 4.4. Route of Administration and Dosage

The current survey revealed that most of the plant remedies are taken orally and topically in the investigated region while only single recipe is taken through ear (Table1). As mentioned earlier, gastrointestinal and skin problems are common in the region and that might be the reason why the majority of the plants are being used orally and topically while some of the plants are being used through ears. Ethnomedicines are taken along different types of additives generally called vectors like honey, salt, sugar, milk, desi ghee, and wheat flour for the purpose of increasing flavor and to reduce the astringent taste of the remedies. This means that since traditional medicines could have sour or bitter tastes in most cases, the additives reduce such tastes and may even improve the efficacy of the medicine. The measurements used to determine the dosages are not standardized and depend on the age and physical appearance of the patient, sociocultural explanation of the illness, diagnosis, and experience of individual herbalist [42]. Mostly the treatment of the patient is completed within a single day or couple of days. When the patients did not show any indication of improvement from their sickness following treatment completion, they were recommended to modern health centres in urban area for further examination by the physician.


## 4.5. Multipurpose Medicinal Plants and Threats to Their Extinction

The results of the DMR implementation on multipurpose medicinal plants enabled us to recognize which of the multipurpose plants are more under stress in the area and the causes that threaten the plant (Table4). Accordingly,Olea ferruginea ranked first,Morus alba ranked second,Melia azedarch ranked third, andAcacia modesta ranked fourth whileAcacia nilotica ranked fifth. These multipurpose species are basically trees and therefore these species are facing great pressures as the local people are unsustainably harvesting these species for a variety of purposes. The factors responsible for the declining of these species abundance in the area were their overharvesting for agricultural tool, construction, fodder, and fire wood purposes. Beside these major threats, locals of the region also use these plants for handicrafts manufacturing. Free grazing is the common practice in the area. Before the commencement of winter, the grasses are harvested, dried, and put into a stake. The harvesting is done collectively, and then during the bare and cold months of winter, these are fed to the domestic animals. Fuel consumption per home in the studied area is often considered more than the consumption on feeding and other requirements because of severe winters. Thus, the results require urgent conservation strategies to save the declining population of multipurpose plant species in the study region. References [43, 44] have also stated the identical pattern of maximum exploitation of multipurpose medicinal plants for uses other than their traditional medicinal importance in southeastern Ethiopia. Traditional healers mostly use the whole plant of these multipurpose species or individual roots (Table 1) of some species for the preparation of ethnomedicinal recipes and this is an unsustainable practice as compared to leaves. Therefore, there is a dire need to take necessary steps for the conservation of these species before their extinction.Table 4
DMR score of fifteen key informants for eleven medicinal plants species with additional uses besides medicinal value.
Usediversity
A. modesta
P. chinensis
D. viscosa
D. sissoo
M. azedarach
M. alba nigra
O. ferruginea
F. religiosa
P. roxburghii
A. nilotica
Z.  mauritiana
Total
Rank
Agriculturaltool
2
0
3
0
4
5
5
0
1
5
0
25
4
Construction
0
4
0
5
5
5
5
5
4
3
2
38
3
Fodder
5
3
0
0
0
5
3
3
0
0
4
23
5
Fire wood
5
3
5
3
5
4
5
4
3
5
3
45
1
Medicine
5
3
3
3
4
5
5
2
3
3
3
39
2
Total
17
13
11
11
18
20
23
14
11
16
12
Rank
4
7
9
9
3
2
1
6
9
5
8
Based on use criteria (5 = best; 4 = very good; 3 = good; 2 = less used; 1 = least used; and 0 = no value).


## 4.6. Indigenous Knowledge Associated with Gender, Age, and Socioeconomic Status of the People

Among the 55 informants, 34 (61.81%) were male and 21 (38.18%) were female (Table5). It is witnessed that males had better knowledge regarding ethnomedicines than females. The reason behind that men have well indigenous knowledge than women might be due to the fact that the men are usually favoured in the shift of the knowledge; however, in many cultures women are responsible for the family’s health. The highest number of informants aged above 40 years. The result shows that traditional knowledge is prevalent among the community members; however, it is under threat of transferring to the younger generation to come. The decreasing rate of transfer of indigenous knowledge might be due to the lack of interest among the younger generation to learn and practice it, which might be attributed to the ever increasing influence of modernization [8]. Almost half of the respondents interviewed were illiterate (45.45%), whilst most of those with an education had merely primary (29.09%) which reflect the unavailability of standard educational institution in the area (Table 5). Literate people in the study area were found to have less knowledge of medicinal plants as compared to illiterate ones as the former are more likely to be exposed to modernization as also revealed by studies conducted elsewhere [8, 45, 46]. The inhabitants of the study area are not very well off due to less literacy rate and therefore they are heavily dependent on medicinal plants for a variety of purposes in order to compensate their income.Table 5
Gender, age group and literacy level frequencies, and occupation of the interviewed people in the region.
Total
Percentage
Gender
Male
34
61.81
Female
21
38.18
Age groups
20–29
2
3.63
30–39
3
5.45
40–49
7
12.72
50–59
7
12.72
60–69
15
27.27
70–79
12
21.81
80–89
9
16.3
Educational attainment
Illiterate
25
45.45
Primary
16
29.09
Middle
10
18.18
Secondary
2
3.63
University
2
3.63
Occupation
Females
House wives
19
90.47
Primary teacher
2
9.52
Males
Shopkeepers
10
29.4
Farmers
13
38.2
Labours
6
17.6
Primary teachers
5
14.7


## 5. Conclusions

The present study has recorded 67 medicinal plants used for the treatment of a variety of human ailments in the rural area near Pak-Afghan border region. In the study area herbs constituted the highest proportion of medicinal plants to be utilized. Mostly the leaves of the plants are harvested for different ethnomedicines preparation. Decoction and powdering are the most common methods of drug preparation and remedies are mostly taken orally in the studied region. A high number of plants have been reported to treat gastrointestinal and dermatological problems. The medicinal plants in the region are also facing some threats like unsustainable collection method of some plants, collection for fuel wood, for construction, and for fodder, and agricultural tools. For sustainable utilization of medicinal plants and to avoid further loss, the District Agricultural Office needs to team up with the local people, by providing the community with planting materials of the most threatened and preferred medicinal and multipurpose species so that they can grow them in their home gardens. Moreover, the documented medicinal plants with high degree of consensus can serve as a basis for future investigation of modern drug.



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*Source: 635371-2014-05-20.xml*