# Yerba Mate(Ilex paraguariensis) Beverage: Nutraceutical Ingredient or Conveyor for the Intake of Medicinal Plants? Evidence from Paraguayan Folk Medicine

Authors: Monika Kujawska
Journal: Evidence-Based Complementary and Alternative Medicine
 (2018)

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## Abstract

The use of medicinal plants mixed with yerba mate(Ilex paraguariensis) has been poorly studied in the ethnopharmacological literature so far. The Paraguayan Mestizo people have the longest tradition of using the yerba mate beverage, apart from the indigenous Guarani people. This study analyses the role of yerba mate and medicinal plants in the treatment of illnesses within Paraguayan folk medicine. The research was conducted among 100 Paraguayan migrants living in Misiones, Argentina, in 2014 and 2015. Yerba mate is not considered to be a medicinal plant by its own virtues but is culturally a very important type of medicinal plant intake. Ninety-seven species are employed in hot and cold versions of the yerba mate beverage. The most important species are as follows:Allophylus edulis (highest number of citations),Aristolochia triangularis (highest relative importance value), andAchyrocline flaccida andAchyrocline tomentosa(highest score by Index of Agreement on Species). The plants are used in the treatment of 18 medicinal categories, which include illnesses traditionally treated with plants: digestive system, humoral medicine, and relatively new health conditions such as diabetes, hypertension, and high levels of cholesterol. Newly incorporated medicinal plants, such asMoringa oleifera,are ingested predominantly or exclusively with themate beverage.


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## Body

## 1. Introduction

Yerba mate (Ilex paraguariensisA.St.-Hil., Aquifoliaceae) is a native tree growing in the subtropics of South America, present in Southern Brazil, Northeastern Argentina, Eastern Paraguay, and Uruguay [1]. The yerba mate beverage has been consumed traditionally by Guarani indigenous people since before the conquest of South America by the Spaniards [2]. The commercial potential of this plant was discovered by the Jesuits, who brought wild growing yerba mate into cultivation. Pedro de Montenegro, a Jesuit monk, in hisMateria Medica Misionera described the use of the most important species for the Guarani people, in which yerba mate appeared on the top of the list [3]. The Guarani name for yerba mate iska’a which means “a plant” or “a herb”; hence yerba mate has been considered by this group as the plantpar excellence [3]. Yerba mate was also known as Jesuit tea or Paraguayan tea and shipped as such to Europe [2]. With the expulsion of the Jesuits in 1768, the plantations went wild. By this time, the yerba mate beverage was already popular among Mestizo people (of Spanish and Guarani origin). Since the end of the 19th century, it also became a daily beverage for the European migrants who partly colonized Southern Brazil, Northeastern Argentina, and, to a lesser extent, Eastern Paraguay [4]. Nowadays yerba mate is consumed at the rate of more than one litre per day by millions of people in the above-mentioned countries [4, 5]. It plays a very special social role and constitutes a very important form of caffeine intake [2, 4, 5]. Its popularity is also increasing outside South America due to its pharmacological properties, proven to be beneficial to health [4, 6, 7]. It is also a very important drink in Syria and Lebanon due to Syro-Lebanese migration to Argentina in the second half of the 19th century. Many migrants who returned to the Levant in the 1920s took the habit of drinkingmate with them [8, 9].Over the last 20 years there has been an increase in studies of the pharmacologic properties ofIlex paraguariensis, which have been reviewed [4, 6, 7, 10]. Numerous active compounds have been identified in yerba mate. Phenolic compounds predominate caffeoyl derivatives (caffeic acid, chlorogenic acid) [11, 12], xanthines (caffeine and theobromine), which are a class of purine alkaloids found in many other plants such as tea and coffee, flavonoids (quercetin, kaempferol, and rutin), and tannins [7]. Numerous triterpenoid saponins have also been identified, including those derived from ursolic acids known as metasaponins [4, 7]. Saponins are responsible for the distinct flavour of yerba mate extracts [7]. Yerba mate also contains minerals (P, Fe, and Ca) and vitamins (C, B1, and B2) [13].Research on extracts and isolated compounds from yerba mate has provided a number of pharmacological applications. Studies have demonstrated that yerba mate leaves have antioxidant [11], antiobesity [14, 15], antidiabetic, digestive improvement and cardiovascular properties [16, 17], and chemopreventative ones (preventing cellular damage that may cause chronic diseases) [18]. The consumption of yerba mate infusion reduces LDL-cholesterol in parallel with an increase in HDL-cholesterol, as observed in studies on humans [19]. Yerba mate extract also reduces acute lung inflammation, as observed in the animal model [4]. Antimicrobial activity ofIlex paraguariensis has been recently studied as well [20].Some ethnobotanical studies from the south cone of South America report medicinal uses of yerba mate beverage [21, 22]. Few ethnobotanical and ethnopharmacological studies mention that various medicinal plants are consumed together with the yerba mate beverage by Mestizo and European migrants living in Argentina and Paraguay [23–26]. However, very little is known about how medicinal plants are combined with yerba mate beverage by local people. Additionally, medicinal plant use by Paraguayan Mestizo people is poorly documented in the English-language scientific literature, with very few exceptions [23, 26–30]. The documentation of medicinal plants and analysis of traditional knowledge related to the yerba mate beverage by Paraguayan Mestizo people is of paramount importance for two reasons: (1) apart from indigenous Guarani peoples, they have the longest tradition of using yerba mate and mixing it with medicinal plants; (2) The Paraguayan people are described in the literature as knowledgeable about medicinal plants [30, 31]. Nearly 80% of the population of Paraguay consume medicinal plants on a daily basis [30]. However, the relationship between traditional uses and pharmaceutical properties is poorly studied.The objectives of this contribution were to (1) document and analyse the role of yerba mate in prophylaxis and treatment by Paraguayan Mestizo people; (2) evaluate the role of medicinal plants in yerba mate beverages, and (3) describe the scope of illnesses treated with yerba mate beverage and medicinal plants. Additionally, two questions guided my research and analysis: (1) Does any pattern exist showing that particular illnesses are treated with a hot version of yerba mate beverage and others with a cold one? (2) How receptive is this traditional mode of plant administration to new health challenges and new medicinal plants, previously unknown to the Paraguayan people?


## 2. Material and Methods

### 2.1. Study Area and Ethnographic Setting

The research was conducted among Paraguayan migrants living in the province of Misiones, Argentina. Misiones borders with Paraguay and Brazil and is primarily a semideciduous Atlantic Forest. The Atlantic Forest is one of the most diverse ecosystems in the world [32]. The climate is subtropical humid with no dry seasons, a mean annual rainfall of 2,000 mm, and a mean annual temperature of 20°C [33]. Currently, nearly 40% of original forest cover is preserved in Argentina, in contrast to Brazil and Paraguay, where it comprises approximately 8% [34]. The flora of Misiones comprise 3000 vascular plants, of which more than 500 species have been used for phytotherapeutic purposes by the different ethnic groups living there: the indigenous Guarani people, Mestizos of different origins (Argentinean, Paraguayan, and Brazilian) and European migrants [35].The colonial policy in Paraguay, which was based not on mineral extraction but on settlement, resulted in the early emergence of an entirely new Paraguayan Mestizo culture, neither Spanish nor Guarani, but influenced by both of them [36, 37]. Within Mestizo culture, the Guarani language was preserved, as well as native customs and knowledge. Paraguayan Mestizo people have had the contact with European phytotherapeutic traditions since early colonial times, when they were introduced by Catholic nuns and monks, who promoted the use of well-known medicinal plants from the Mediterranean region, such asArtemisia,Ruta,Mentha, andRosmarinus, as well as Asian species, such asCymbopogon citratus andCitrus spp. [38]. The basic Hippocratic and humoral concepts were introduced through the same channels [39, 40].Since the 19th century,Criollos (the local name for Mestizos) have been coming to Misiones from Paraguay. According to the 2010 census, the Paraguayan community in Argentina accounts for 550.713 persons. This figure represents 30.5% of all immigrants in the country and approximately 8.6% of the total population of Paraguay [41]. The push and pull factors for migration were both economic and political in character. Paraguayan migrants have been regarded as having low formal educational levels, especially those migrating to Argentina in the 1970s, who comprise the majority of the study population. In Misiones, Paraguayan people found employment in the agricultural and forestry sectors.Given that in Misiones the natural environment is generally better preserved than it is in Paraguay [32], Paraguayan migrants originating from the same ecoregion of the Atlantic Forest have presumably found better conditions for implementing and transmitting their traditional ethnomedicine than they did in their own country of origin.


### 2.2. Data Collection

The research was conducted among 100 Paraguayan migrants, 61 women (aged between 30 and 95, mean 61) and 39 men (aged between 28 and 90, mean 61,5). Thirty-two participants were born in Misiones, Argentina, while 68 hailed from the Eastern provinces of Paraguay within the same ecoregion of the Atlantic Forest. The data were collected during two phases of fieldwork, lasting three months each in 2014 and 2015. The free listing technique was applied [42]. Each informant was asked to name all the medicinal plants she/he knew and used (emphasis was placed on personal experience). When a list of names was produced, further questions were asked relating to parts used, medicinal uses, forms of administration, and modes of obtaining the plants.The research took place in three localities, on a gradient from rural to urban, with the semirural component predominating. The three localities—Wanda with Puerto Wanda as one unit, Piray Km 18 (Puerto Piray municipality), and Puerto Leoni—are situated on the bank of the Parana River, the border between Argentina and Paraguay (Figure1). In general terms, the study participants can be described as small scale farmers working on 1-2-hectare plots(chacras), where they cultivate staple crops such as manioc and maize. In addition, male participants usually find off-farm employment, mainly in the forestry industry.Figure 1
Distribution of the study localities, Misiones, Argentina.The documented botanical taxa are supported with voucher herbarium specimens stored in the CTES herbarium in the Instituto de Botánica del Nordeste (IBONE), Corrientes, Argentina, and in the herbarium of the Museo Argentino de Ciencias Naturales “Bernardino Rivadavia” in Buenos Aires (BA). Prior to each interview, study participants gave oral informed consent for their participation. There was no requirement for the project to pass any ethical commission, either in Argentinian or in Polish institutions, as the informants were not subject to any other treatment than voluntary interviews.


### 2.3. Data Analysis

In order to analyse the scope of medicinal categories, which include body systems, and determine the most important illnesses treated with yerba mate extracts, two measures were used as a proxy: number of species and use reports (UR). A use report is defined here as a description by an informant (i) of species (s) used for a medicinal purpose (p); hence two different medicinal uses of a given species reported by the same informants are counted as two use reports [43].The relative importance (RI) value was calculated for each plant species based on the normalized number of medicinal uses attributed to it and the number of body systems/medicinal categories it treated [38]. Relative importance is a versatile index, which shows the extent of medicinal application of a given species. The reasons for versatile use of a species may be very diverse; for example, this may reflect a trial-and-error effort—a constant search for accurate or new medicinal applications for some widely available species. Taking this into account, another index was also used, the Index of Agreement on Species (IAS) [43], to measure the consistency of medicinal uses of a given species. This is a modified version of Index on Agreement of Remedies developed by Trotter and Logan [44].The Sørensen similarity coefficient was used to check whether similar plants were used in the treatment of apparently similar illnesses. The formula is as follows: Ss =2a/(2a + b + c), where a is number of shared species, b is number of exclusive species in group 1, and c is number of exclusive species in group 2. The result is then multiplied by 100, in order to express it as a percentage.


## 2.1. Study Area and Ethnographic Setting

The research was conducted among Paraguayan migrants living in the province of Misiones, Argentina. Misiones borders with Paraguay and Brazil and is primarily a semideciduous Atlantic Forest. The Atlantic Forest is one of the most diverse ecosystems in the world [32]. The climate is subtropical humid with no dry seasons, a mean annual rainfall of 2,000 mm, and a mean annual temperature of 20°C [33]. Currently, nearly 40% of original forest cover is preserved in Argentina, in contrast to Brazil and Paraguay, where it comprises approximately 8% [34]. The flora of Misiones comprise 3000 vascular plants, of which more than 500 species have been used for phytotherapeutic purposes by the different ethnic groups living there: the indigenous Guarani people, Mestizos of different origins (Argentinean, Paraguayan, and Brazilian) and European migrants [35].The colonial policy in Paraguay, which was based not on mineral extraction but on settlement, resulted in the early emergence of an entirely new Paraguayan Mestizo culture, neither Spanish nor Guarani, but influenced by both of them [36, 37]. Within Mestizo culture, the Guarani language was preserved, as well as native customs and knowledge. Paraguayan Mestizo people have had the contact with European phytotherapeutic traditions since early colonial times, when they were introduced by Catholic nuns and monks, who promoted the use of well-known medicinal plants from the Mediterranean region, such asArtemisia,Ruta,Mentha, andRosmarinus, as well as Asian species, such asCymbopogon citratus andCitrus spp. [38]. The basic Hippocratic and humoral concepts were introduced through the same channels [39, 40].Since the 19th century,Criollos (the local name for Mestizos) have been coming to Misiones from Paraguay. According to the 2010 census, the Paraguayan community in Argentina accounts for 550.713 persons. This figure represents 30.5% of all immigrants in the country and approximately 8.6% of the total population of Paraguay [41]. The push and pull factors for migration were both economic and political in character. Paraguayan migrants have been regarded as having low formal educational levels, especially those migrating to Argentina in the 1970s, who comprise the majority of the study population. In Misiones, Paraguayan people found employment in the agricultural and forestry sectors.Given that in Misiones the natural environment is generally better preserved than it is in Paraguay [32], Paraguayan migrants originating from the same ecoregion of the Atlantic Forest have presumably found better conditions for implementing and transmitting their traditional ethnomedicine than they did in their own country of origin.


## 2.2. Data Collection

The research was conducted among 100 Paraguayan migrants, 61 women (aged between 30 and 95, mean 61) and 39 men (aged between 28 and 90, mean 61,5). Thirty-two participants were born in Misiones, Argentina, while 68 hailed from the Eastern provinces of Paraguay within the same ecoregion of the Atlantic Forest. The data were collected during two phases of fieldwork, lasting three months each in 2014 and 2015. The free listing technique was applied [42]. Each informant was asked to name all the medicinal plants she/he knew and used (emphasis was placed on personal experience). When a list of names was produced, further questions were asked relating to parts used, medicinal uses, forms of administration, and modes of obtaining the plants.The research took place in three localities, on a gradient from rural to urban, with the semirural component predominating. The three localities—Wanda with Puerto Wanda as one unit, Piray Km 18 (Puerto Piray municipality), and Puerto Leoni—are situated on the bank of the Parana River, the border between Argentina and Paraguay (Figure1). In general terms, the study participants can be described as small scale farmers working on 1-2-hectare plots(chacras), where they cultivate staple crops such as manioc and maize. In addition, male participants usually find off-farm employment, mainly in the forestry industry.Figure 1
Distribution of the study localities, Misiones, Argentina.The documented botanical taxa are supported with voucher herbarium specimens stored in the CTES herbarium in the Instituto de Botánica del Nordeste (IBONE), Corrientes, Argentina, and in the herbarium of the Museo Argentino de Ciencias Naturales “Bernardino Rivadavia” in Buenos Aires (BA). Prior to each interview, study participants gave oral informed consent for their participation. There was no requirement for the project to pass any ethical commission, either in Argentinian or in Polish institutions, as the informants were not subject to any other treatment than voluntary interviews.


## 2.3. Data Analysis

In order to analyse the scope of medicinal categories, which include body systems, and determine the most important illnesses treated with yerba mate extracts, two measures were used as a proxy: number of species and use reports (UR). A use report is defined here as a description by an informant (i) of species (s) used for a medicinal purpose (p); hence two different medicinal uses of a given species reported by the same informants are counted as two use reports [43].The relative importance (RI) value was calculated for each plant species based on the normalized number of medicinal uses attributed to it and the number of body systems/medicinal categories it treated [38]. Relative importance is a versatile index, which shows the extent of medicinal application of a given species. The reasons for versatile use of a species may be very diverse; for example, this may reflect a trial-and-error effort—a constant search for accurate or new medicinal applications for some widely available species. Taking this into account, another index was also used, the Index of Agreement on Species (IAS) [43], to measure the consistency of medicinal uses of a given species. This is a modified version of Index on Agreement of Remedies developed by Trotter and Logan [44].The Sørensen similarity coefficient was used to check whether similar plants were used in the treatment of apparently similar illnesses. The formula is as follows: Ss =2a/(2a + b + c), where a is number of shared species, b is number of exclusive species in group 1, and c is number of exclusive species in group 2. The result is then multiplied by 100, in order to express it as a percentage.


## 3. Results and Discussion

### 3.1. Social and Medicinal Context of DrinkingMate andTereré

The sources describe four different forms of drinking processed minced leaves and stems of yerba mate [10], but the representatives of the Paraguayan community in Misiones use two basic forms of ingesting it—a hot version calledmate and a cold one:tereré. In general terms,mate is drunk all the year round, usually in the morning and in the afternoon. On hot summer days the afternoonmate may be replaced bytereré. Additionally,tereré may be drunk at noon, before lunch, and during the summer (December–March). On a few occasions, male informants mentioned that they would drinktereré the whole year round, independently of the weather. These observations stay in line with reports from rural areas of Paraguay [23, 26].The hot beverage,mate, is normally prepared in a gourd (Lagenaria spp.) also calledmate. A metal straw,bombilla, is used to ingest the extract. Industrialized yerba mate is always chosen, preferably the one with stems(con palo). According to the informants, such yerba mate does not wash away rapidly and less powder is ingested, compared to yerba mate without stems(sin palo). Small amounts of hot water (77–80°C) are repeatedly poured over a serving, ca. 50 g of packed processed yerba mate. Yerba mate may be poured from a thermos or directly from a steel kettle. The second method normally takes place in the kitchen with a stove, where the kettle can be heated up.The cold beverage—tereré—is drunk virtually from any container. Normally plastic, metal, or glass cups are used or those made from bamboo-like plants (Chusquea spp.). A metal or bamboobombilla is used. Another bigger container is filled with cold water and some other additives (Figure 2). In this case, industrially processed yerba mate is also used, but there is alsoyerba canchada—especially processed for drinkingtereré, in which leaves are crushed into large pieces.Figure 2
Tereré withkokû leaves(Allophylus edulis) prepared for a noon round on a hot summer day (Piray Km 18, Puerto Piray Municipality, Misiones, 2014).The medicinal plants used withmate are placed in a thermos or in the gourd. Whenever hard plant parts are used, such as bark or roots, they are placed in a thermos with hot water or in a kettle. Leaves, stems, and flowers are placed directly in the gourd with yerba mate. Some Paraguayans also add sugar tomate—a spoonful is added to the yerba mate every round or every second round (themate server starts from her/himself and then pours water into a gourd for each person in a clockwise order). When thetereré is prepared, all the medicinal plants are placed in a container with cold water, and sometimes ice is added. If time permits, plants are left for several minutes to macerate. Sometimes the maceration process is accelerated, by squeezing leaves in the hands to stimulate the release of juices into the water. I have never, however, observed the use of mortars to crush medicinal plants before adding them to cold water in order to prepare the medicinal maceration fortereré—something widely practiced in Paraguayan cities, for example, Asunción and Encarnación (Figure 3).Figure 3
Medicinal plants, additives totereré, and mortars in the Asunción market.Drinking yerba mate is social behaviourpar excellence. People avoid drinkingmate ortereré on their own. The afternoonmate, especially, is shared with family, neighbours, friends, and other visitors. Sometimes the addition of medicinal plants is negotiated among the participants, and in other situations the invited persons ingest the plants which the host is currently drinking with his/her yerba mate. Of anecdotal character is the story told by local doctors that Mestizo women (not necessarily of Paraguayan origin) in Misiones would add contraceptive pills tomate and then drink it with family and relatives.Yerba mate itself is not perceived as a medicinal plant by the study community. Just one person mentioned its sole use as medicinal. Nor is it conceived as a nutraceutical ingredient; at least this was never expressed explicitly by informants. Hence, it is the medicinal plants, used together withmate ortereré, that determine the medicinal properties of a yerba mate beverage. Occasionally, plants are used to improve the taste or give a flavour to yerba mate without clear medicinal cues; rosemary(Rosmarinus officinalis), mint (Mentha spp.), and lemon grass(Cymbopogon citratus) are used in this way. The importance of the yerba mate beverage as a vehicle for medicinal plants intake was also reported in another study from Paraguay. Goyke [26] stated that, for all the top scoring plants, yerba mate was either the typical or the exclusive way people consumed them. This shows how important yerba mate is medicinally, though not by its own virtue. In this sense, these findings differ from what is reported in pharmacological literature [7].Some epidemiological studies have reported an association between the consumption of yerba mate and increased risk of various types of cancer, including oral, laryngeal, and bladder cancer [7, 45, 46]. During my field campaign in 2014 this message was spread by radio, television, and newspapers to the general audience in Argentina. Information about the potential carcinogenic effects of drinking yerba mate produced serious concern among informants about the future of their habit. Nonetheless, the subsequent message that spread rapidly among them was that drinkingmate too hot might produce cancer, which was heard with deep relief.


### 3.2. Characteristics of Plants Used withMate andTereré

The Paraguayan community in Misiones uses 97 medicinal plant species (552 UR) together withmate (58 species),tereré (17), or both (22) (Table 1). Of these 97 species, 63 are native, 30 introduced, and four naturalized. Most of the plants come from cultivation (43), followed by species gathered from the wild (39); however 12 species have been reported as cultivated by some informants and collected from ruderal areas by others. Only four species were purchased in the market or from Paraguayan ambulatory sellers—women who bring plant for sale from Paraguay through the border on the Parana River.Table 1
List of medicinal plants used withmate and tereré beverages by Paraguayan migrants living in Misiones, Argentina.
Botanical name Local name Plant part used Medicinal use Mode of administration Status Number of use reports Relative importance (RI) Index of Agreement on Species (IAS) Acanthospermum australe (Loefl.) Kuntze, Asteraceae, CTES0049658 Tapekue Leaves, aerial parts Ulcers, digestion problems In mate Native 5 13 0,75  Achyrocline flaccida (Weinm.) DC. Asteraceae, CTES0032301; Achyrocline tomentosa Rusby, Asteraceae, CTES0049806 Marcela, jate’i ka’a Flower Digestion problem, stomach ache, hot remedy In mate Native 17 26,5 0,875  Acrocomia aculeata(Jacq.) Lodd. ex Mart.,Arecaceae Coco Leaves Hypertension, digestion problem In tereré Native 3 18,5 0,5  Allophylus edulis(A.St.-Hil., A. Juss. & Cambess.) Radlk., Sapindaceae, CTES0026306 Kokû Leaves Cold remedy, digestion problem, heartburn, hapatitis, blood cleansing, hypertension, hangover, prophylactic In tereré Native 34 64,5 0,74  Aloe arborescens Mill.,Xanthorrhoeaceae Aloe de hoja angosta Leaves Cancer, heart problem In mate Introduced 3 18,5 0,5  Aloysia citriodora Palau, Verbenaceae, CTES0026156 Cedrón Leaves Heart problem In mate Native 1 9,5 0  Aloysia gratissima (Gillies & Hook.) Tronc., Verbenaceae, CTES0049841 Poleo de palo Leaves Digestion problem In mate Native 1 9,5 0  Aloysia polystachya(Griseb.) Moldenke, Verbenaceae, CTES0032292 Burrito Leaves Digestion problem, stomach ache, hypertension, prophylactic In mate Native 12 32 0,72  Aloysia pulchra(Briq.) Moldenke, Verbenaceae, CTES0049842 Poleo Leaves Infecctions In mate Native 1 9,5 0  Anethum graveolensL., Apiaceae, BA92101 Eneldo Seeds Digestion problem, stomach ache In mate Introduced 2 13 0  Annona muricata L., Annonaceae Graviola Leaves Cancer In mate Introduced 2 9,5 1  Aristolochia triangularis Cham., Aristolochiaceae, CTES0026276 Ysypo milhombre(s) Liana Blood cleansing, urinary infection, hypertension, cramps, abortive, contraceptive, restores menstruation, venereal disease, digestion problem, infections, internal cold, rheumatism, cure-all, prophylactic In mate Native 28 100 0,55  Artemisia absinthiumL., Asteraceae, CTES0030264 Ajenjo Leaves Stomach ache, digestion problem, diabetes, cure-all In mate Introduced 10 30 0,67  Baccharis gaudichaudiana DC., Asteraceae, CTES0026286 Chirca melosa Leaves Blood cleansing, digestion problem, stomach ache In mate Native 3 22,5 0  Baccharis trimera(Less.) DC., Asteraceae, CTES0032297 Jaguarete ka’a, carqueja Leaves Digestion problem, stomach ache, diabetes, high level of cholesterol, blood cleansing, hangover In mate Native 19 50,5 0,72  Bauhinia forficataLink, Fabaceae, CTES0049618 Pata del buey Leaves Kidney infection In mate and tereré Native 2 9,5 1  Bauhinia microstachya(Raddi) J.F.Macbr., Fabaceae, CTES0032148 Ka’i escalera, pata del buey’i Liana Urinary infection, liquid retention, diabetes In mate and tereré Native 7 22,5 0,67  Begonia cucullata Willd., Begoniaceae, BA92089 Agrial Leaves Aphtha In tereré Native 1 9,5 0  Bidens pilosaL., CTES0049811, Bidens subalternansDC., Asteraceae, CTES0026269 Amor seco, picón Aerial parts Prostate, diabetes, hot remedy In mate Native 3 28 0  Boerhavia diffusa L., Nyctaginaceae, CTES0055777 Ka’arurupe Aerial parts Stomach ache In tereré Introduced 1 9,5 0  Campomanesia sp., Myrtaceae, CTES0049691 Yva hái mi Tree bark Diabetes In mate Native 1 9,5 0  Campomanesia xanthocarpa(Mart.) O.Berg, Myrtaceae, CTES0055662 Guavira Leaves Diarrhea In mate Native 1 9,5 0  Cecropia pachystachyaTrécul, Urticaceae, CTES0032286 Amba’y Leaves, young shoots Cough, bronchitis, rheumatism, gastritis In mate Native 5 31,5 0,25  Cissus verticillata (L.) Nicolson & C.E.Jarvis, Vitaceae, CTES0055762 Insulina Leaves Diabetes In mate Native 2 9,5 1  Citrus × aurantium L., Rutaceae, CTES0032134 Apepu Leaves, fruit Nervous tension, high level of cholesterol In mate and tereré Naturalized 2 18,5 0  Citrus reticulataBlanco, Rutaceae, CTES0032133 Mandarina Leaves Cold sore In mate Introduced 1 9,5 0  Citrus sinensis (L.) Osbeck, Rutaceae, CTES0032133 Naranja Leaves Nervous tension, headache, hypertension In mate Introduced 5 27,5 0,5  Croton sp., Euphorbiaceae, CTES0049687 Sangre de grado Tree bark Diabetes, lack of appetite In mate Native 2 18,5 0  Cyclospermum leptophyllum (Pers.) Sprague, Apiaceae, CTES0049517 Apio’i Aerial parts Cold remedy, hangover, cold sore In tereré Native 5 22,5 0,5  Cymbopogon citratus(DC.) Stapf, Poaceae, CTES0048733 Cedrón Leaves Heart problems, nervous tension, hypertension, digestion problems, prophylactic In mate and tereré Introduced 20 41 0,79  Cynodon dactylon(L.) Pers., Poaceae, CTES0025340 Gramilla Root Liquid retension In tereré Native 1 9,5 0  Dolichandra unguis-cati(L.) L.G. Lohmann, Bignoniaceae, CTES0049524 Uña de gato Rhizome Kidney infection, urinary problems, cold remedy In tereré Native 5 18,5 0,5  Dysphania ambrosioides(L.) Mosyakin & Clemants, Amaranthaceae, CTES0032130 Ka’arê Leaves Hot remedy In mate Introduced 3 9,5 1  Elionurus muticus(Spreng.) Kuntze, Poaceae, CTES0026294 Kapi’i cedrón Leaves Nervous tension In mate Native 1 9,5 0  Equisetum giganteumL., Equisetaceae, CTES0049521 Cola de caballo Leaves Kidney infection, urinary problems, liquid retention, kidney stones In mate and tereré Native 12 20,5 0,72  Eriobotrya japonica(Thunb.) Lindl., Rosaceae, CTES0032147 Níspero Leaves, young shoots Hypertension, all-cure In mate and tereré Introduced 2 18,5 0  Eugenia pyriformis Cambess. var. pyriformis, Myrtaceae, CTES0048743 Yva hái Leaves Diabetes, hypertension, high level of cholesterol In mate and tereré Native 7 18,5 0,66  Eugenia unifloraL., Myrtaceae, CTES0026288 Ñangapiry, pitanga Leaves Hypertension, cold remedy In mate and tereré Native 11 18,5 0,82  Euphorbia prostrata Aiton, Euphorbiaceae Tupasy kamby Aerial parts Liquid retension, blood cleansing In mate Native 2 18,5 0  Euphorbia serpensKunth, Euphorbiaceae, CTES0026291 Tupasy kamby Aerial parts Cold remedy, vaginal discharge In mate Native 2 18,5 0  Foeniculum vulgareMill., Apiaceae, CTES0049511 Aipo, hinojo Aerial parts Muscle pains, overheated stomach In mate and tereré Introduced 2 18,5 0  Gleditsia amorphoides (Griseb.) Taub., Fabaceae, CTES0026088 Ñuatî kurusu Tree bark Hypertension, infection In mate Native 2 18,5 0  Gomphrena celosioidesMart. f.roseiflora(Chodat & Hassl.) Pedersen, Amaranthaceae, CTES0055763 Perudilla Aerial parts Cold remedy, cold sore In tereré Native 4 13 0,67  Guarea macrophylla Vahl subsp.spiciflora (A. Juss.) T.D. Penn., Meliaceae, CTES0026272 Cedrillo Trunk Inernal jab and wound In mate and tereré Native 3 9,5 1  Gyneriumspp., Poaceae Caña brava Root Blood cleansing In mate Native 1 9,5 0  Hemionitis tomentosa(Lam.) Raddi, Pteridaceae, CTES0049653 Doradilla Leaves Vaginal discharge, irregular menstruation, bladder infection, blood cleansing In mate Native 4 31,5 0  Heteropterys glabraHook & Arn., Malpighiaceae, CTES0026280 Tilo Leaves, flower Heart problem, nervous tension In mate Native 2 18,5 0  Hypochaeris chillensis (Kunth) Hieron., Asteraceae, CTES0026099 Achicoria silvestre Root, leaves Cold remedy In tereré Native 6 9,5 1  Jacaranda micrantha Cham., Bignoniaceae, CTES0026265 Karoba Tree bark Blood cleansing, cure-all In mate Native 7 18,5 0,83  Jacaratia spinosa(Aubl.) A.DC., Caricaceae, CTES0032144 Jakarati’a Leaves Hypertension In mate Native 1 9,5 0  Lactuca virosa Habl., Asteraceae, CTES0030265 Lechuga japonesa Leaves Hypertension In tereré Introduced 1 9,5 0  Lippia alba (Mill.) N.E.Br. ex Britton & P.Wilson, Verbenaceae,BA92110 Salvia Leaves, flower Menstrual pain, stomach pain, hot remedy, prophylactic, all-cure In mate Native 8 50,5 0,43  Lippia brasiliensis (Link) T.R.S. Silva, Verbenaceae, CTES0049516 Jate’i ka’a ka’aguy Leaves Abdomen pain, hot remedy, prophylactic In mate Native 3 28 0  Malva parviflora L., Malvaceae, CTES0049514 Malva de castilla Leaves Prophylactic during pregnancy, hot remedy In mate Introduced 2 18,5 0  Mangifera indica L., Anacardiaceae Mango Leaves, seed Hypertension, constipation In mate and tereré Introduced 4 18,5 0,67  Matricaria chamomilla L., Asteraceae, CTES0026285 Manzanilla Inflorescence Menstrual pain, stomach pain, hot remedy, infections, prophylactic In mate Introduced 9 50,5 0,5  Maytenus ilicifolia Mart. ex Reissek, Celastraceae, CTES0048746 Kangorosa Leaves, root, bark Blood cleansing, high level of cholesterol, hypertension, internal infections, ulcers, abdomen pain, urinary infection, hot remedy In mate Native 30 77 0,76  Melilotussp., Fabaceae Alfalfa Aerial parts Rheumatism, eye problem In mate and tereré Introduced 2 18,5 0  Melissa officinalis L., Lamiaceae, CTES0032129 Toronjil Leaves Heart problem, cold remedy In mate and tereré Introduced 2 18,15 0  Menthasp., Lamiaceae [Mentha spicata L. CTES0030909] Menta, menta’i Leaves Nervous tension, heart problem, hypertension, headache, intestinal problems, abdomen pain, hot remedy, cold remedy, yerba mate additive In mate and tereré Introduced 16 58,25 0,53  Moringa oleifera Lam., Moringaceae, CTES0049652 Moringa Leaves Diabetes, high level of cholesterol, cancer, ulcers, digestion problem, kidney infection, urinary problem, prophylactic, all-cure In mate and tereré Introduced 15 69,25 0,43  Morus alba L., Moraceae, CTES0049525 Mora Leaves Hypertension, excessive libido In mate and tereré Introduced 2 18,5 0  Myrocarpus frondosus Allemao, Fabaceae Incienso Tree bark Ulcers In mate Native 1 9,5 0  Ocimum cf.basilicum var.anisatum Benth, Lamiaceae, CTES0030915 Anís Leaves Prophylactic In mate Introduced 3 18,5 1  Panicum tricholaenoides Steud., Poaceae, CTES0032493 Cola de caballo Leaves Kidney infection In mate and tereré Native 2 9,5 1  Parietaria debilis G. Forst., Urticaceae, CTES0055778 Ka’a piky Aerial parts Cold remedy, cold sore, nervous tension, In tereré Native 14 31,5 0,85  Parietaria judaica L., Urticaceae, CTES0049674 Buscapina Leaves Digestion problem In mate Introduced 1 9,5 0  Passiflora alata Curtis, Passifloraceae, CTES0032140 Mburukuja Leaves Nervous tension In tereré Native 1 9,5 0  Peperomia circinnataLink, Piperaceae, CTES0049675 Jatevu ka’a Entire plant Hypertension In tereré Native 2 9,5 1  Persea americana Mill., Lauraceae Palta Seeds Kidney infection In mate Naturalized 1 9,5 0  Persea americana var. drimyfolia(Cham. & Schltdl.) S.F.Blake, Lauraceae, BA92058 Palta anís Leaves Heart problem, liver problem, cold remedy In mate and tereré Naturalized 3 28 0  Petroselinum crispum (Mill.) Fuss, Apiaceae, CTES0049501 Perejíl Leaves Cold remedy In tereré Introduced 1 9,5 0  Phyllanthus niruri L., Phyllanthaceae, CTES0026299 Rompepiedras, quebrapiedra, para’parai Aerial parts Kidney infection, urinary problems, liquid retention In mate and tereré Native 7 17 0,67  Piper mikanianum (Kunth) Steud., Piperaceae, CTES0032289 Pariparoba Leaves Heart problem, abdomen pain, hot remedy In mate Native 5 28 0,5  Plantago australis Lam., Plantaginaceae,BA92072 Llantén Leaves Flu, sore throat, infections, cold sore, blood cleansing, prophylactic, cure-all In mate Native 10 54,5 0,33  Pluchea sagittalis Less., Asteraceae, CTES0048748 Yerba del lucero Leaves Digestion problem In mate Native 1 9,5 0  Rollinia salicifolia Schltdl., Annonaceae, CTES0026257 Aratiku Leaves, flower Hypertension, diabetes In mate Native 4 18,5 0,67  Rosa sp., Rosaceae, CTES0049673 Rosa Flower Constipation In mate Introduced 1 9,5 0  Rosmarinus officinalis L., Lamiaceae, CTES0049845 Romero Leaves Heart problem, nervous tension, abdomen pain, stomach pain, high level of cholesterol, hypertension, blood cleansing, hot remedy, headache, imporves memory, prophylactic, all-cure, yerba mate additive In mate Introduced 32 84,5 0,65  Ruta chalepensis L., Rutaceae, CTES0026289 Ruda Leaves Sore throat, prophylactic In mate Introduced 3 18,5 0,5  Scoparia dulcis L., Plantaginaceae, CTES0049830 Typycha kuratû Aerial parts Digestion problem, stomach ache, diabetes In mate Native 3 22,5 0  Sechium edule (Jacq.) Sw., Cucurbitaceae, CTES0026263 Chuchu, xuxu Leaves Hypertension In mate Naturalized 1 9,5 0  Sida cordifolia L., Malvaceae, CTES0026266 Malva blanca Leaves, flower Vaginal discharge, vaginal infection, irregular menstruation, menstrual pain, prophylactic during pregnancy, hot remedy, blood cleansing, kidney infection, urinary problem In mate Native 19 62 0,55  Smallanthus connatus (Spreng.) H.Rob., Asteraceae, CTES0049444 Jaguarete po Leaves Diabetes, high level of cholesterol, stomach ache In mate and tereré Native 7 28 0,67  Solanum sisymbriifolium Lam., Solanaceae, CTES0032288 Ñuatî pytâ Root Urinary infection In tereré Introduced 1 9,5 0  Solidago chilensis Meyen,Asteraceae, CTES0049655 Teju ka’a, yerba del lagarto Aerial parts Prophylactic In mate Native 1 9,5 0  Sorocea bonplandii (Baill.) W.C. Burger, Lanj.&Wess. Boer, Moraceae, CTES0026282 Ñandypa Root, leaves High level of cholesterol, diabetes, obesity, blood cleansing In mate Native 15 32 0,78  Stachytarpheta cayennensis(Rich.) Vahl, Verbenaceae, CTES0055765 Tatu ruguái, verbena tatu ruguái Aerial parts Prostate, male aphrodisiac In mate and tereré Native 2 13 0  Stevia rebaudiana (Bertoni) Bertoni, Asteraceae, CTES0049664 Ka’a he’ê Leaves Heartburn, diabetes, prophylactic In mate Native 4 28 0,33  Styrax leprosus Hook. & Arn., Styracaceae, CTES0026167 Carne de vaca Tree bark Diabetes, high level of cholesterol In mate Native 4 18,5 0,67  Tabernaemontana catharinensis A.DC., Apocynaceae, CTES0049506 Horquetero Leaves Diabetes, high level of cholesterol In mate Native 2 18,5 0  Tagetes minuta L., Asteraceae, CTES0026292 Suico Leaves, flower Intestinal parasites, empacho (folk illness) In mate Native 2 18,5 0  Tanacetum parthenium (L.) Sch. Bip., Asteraceae, CTES0049661 Manzanilla guasu Flower Stomach ache In mate Introduced 1 9,5 0  Urera baccifera (L.) Gaudich. ex Wedd., Urticaceae, CTES0026278 Ortiga grande Root Urinary problem, liquid retension, blood cleansing In tereré Native 4 22,5 0,33  Verbena litoralis Kunth, Verbenaceae, CTES0026305;Verbena montevidensis Spreng.,Verbenaceae, BA92064 Verbena Leaves Stomach ache, digestion problem, lack of appetite, fever, diabetes, cold remedy, blood cleansing, hangover, headache, cure-all In tereré Native 18 66 0,59  Xanthium spinosum L., Asteraceae, CTES0049666 Cepacaballo, abrojito Leaves Digestion problem, liver problem, cold remedy In mate and tereré Introduced 3 22,5 0  Zea mays L., Poaceae Barba de choclo Flower Urinary problem In mate Introduced 2 9,5 1Allophylus edulis,kokû, is the plant with the highest number of citations (30) and UR (34) (Figure 4). It is used only withtereré and is a “cold” remedypar excellence for Paraguayan people. It is also widely used in the treatment of digestive tract illnesses, hepatitis, and hypertension. Some pharmacological properties of this species are known, which largely coincide with the folk use, according to whichA.edulis acts as a hepatoprotector (flavonoids) and angiotensin converting enzyme (ACE) inhibitor [47].Figure 4
Species with the highest number of citations and relative importance value.The most versatile plant species (with the highest RI value) isAristolochia triangularis,ysypo milhombre(s). This species is only applied inmate. It is used in the treatment of nine different categories, the most important being humoral medicine (blood cleansing), but also urinary (infections) cardiovascular (hypertension), reproductive, digestive, and musculoskeletal (rheumatism) systems, and for general infections. Its use in the reproductive health category is unclear. For some informants,A. triangularis is a contraceptive or an abortifacient agent, when used in greater doses, and for others it cures venereal diseases and enhances male potency—this latter information is inscribed in the plant nameysypo [liana]milhombre(s) [thousand-men]. All informants agreed that it should be used with caution; however they could not explain what the exact side effects might be. Given its popularity among the Paraguayan community, there is surprisingly little information published on the folk medicinal use ofA.triangularis, just two reports from Argentina [48, 49], one from Brazil [50], and a few general ones from South America [51]. The only pharmacologically tested properties found so far are cytotoxic [49]. The known chemical compounds are alkaloids, essential oils, lignans, terpenoids, saponins, tannins, and aristolochic acids (AAs) [52–54]. In the ethnopharmacological review by Heinrich et al. [51], differentAristolochia spp. were described, includingA.triangularis. Since it also contains aristolochic acids, the consumption of the species poses a risk. In China and Europe species ofAristolochiahave been associated with nephropathy, but there is a lack of data about the potential risk of renal toxicity from consuming AAs in South American literature [51].The species with the highest consistency and consensus on use, measured by Index of Agreement on Species (IAS), were those with just one use mentioned by two or three respondents. One of the taxa with a parallel high number of citations and IAS score wasAchyrocline spp. There are two species used indiscriminately within this genus:Achyrocline flaccidaandAchyrocline tomentosacalledjate’i ka’a andmarcela. These taxa are used for digestion problems and as “hot” remedy and they are always applied inmate by Paraguayan people. The importance ofAchyrocline species in Paraguayan folk medicine was already highlighted by Schmeda-Hirschmann and Bordas [23]. According to pharmaceutical studies,A.flaccidapossesses antiviral and antibacterial activity [55, 56]. It contains caffeoyl derivatives, essential oils, flavonoids, and sesquiterpenes [57]. Phytochemical studies ofA.tomentosa reported the presence of flavonoids as well as 27 mayor and trace elements [58, 59].Other species from the list of the most cited ones and with the highest RI value, include native plants such asMaytenus ilicifolia,Baccharis trimera,Sida cordifolia, andVerbena litoralis/Verbena montevidensis—used indiscriminately. All of them have been studied phytochemically [60]. There are also four introduced plants on this list, all of them well studied:Rosmarinus officinalis,Cymbopogon citratus, andMentha spp. with a long tradition of use andMoringa oleifera which has only recently (in the last 5-6 years) been incorporated by Paraguayan migrants in Misiones.How many antidiabetic properties can be found in the plants used to treat diabetes by Paraguayan people? The study community uses 17 different plant species withmate andtereréto treat diabetes mellitus type 2. From this group onlyMoringa oleifera [61, 62] andScoparia dulcis [63] have been confirmed to possess antidiabetic properties. Interestingly, Paraguayan migrants, through their family and friendship channels, obtain seedlings ofCissus verticillata andSmallanthus connatus from Paraguay, as potent antidiabetic plants.C.verticillata is calledinsulina by them; however so far only antifungal activity has been ascribed to this species [64]. Therefore, only a small portion of the plants used as antidiabetic by Paraguayan people have been proven to possess pharmacologically tested properties for diabetes. Most probably the pharmacological action in the treatment of this health problem may be ascribed directly toIlex paraguariensis, while informants see it in the properties of medicinal plants used with yerba mate. The question here may be whether medicinal plants with pharmacologically tested antidiabetic properties have an additive or synergetic function in the beverage.A similar question was posed in the context of hypertension—another chronic problem for which the Paraguayan community in Misiones uses 19 different species. From this list, onlyEugenia uniflora has been assigned clear hypotensive activity [65, 66]. Indeed, this species is applied inmate andtereré with the highest frequency, with the function of decreasing blood pressure.These two health problems have been incorporated into phytotherapy most recently by the Paraguayan people, and comparison with the pharmaceutical literature shows that Paraguayan people are still in the process of using trial-and-error to find adequate herbal medicines, efficacious in the treatment of these health conditions. The relatively high number of species used for these events also indicates a personalistic approach to the search for the right drug.


### 3.3. Characteristics of Illnesses Treated with Mixtures Based on the Yerba Mate Beverage

Medicinal plants are used for their preventive and curative properties. The scope of illnesses treated with medicinal plants used inmate andtereré is very wide. Eighteen use categories have been reported, including 10 body systems (Figure 5). The most important categories are digestive, followed by humoral medicine, cardiovascular, endocrinological, and urinary categories. Interestingly, respiratory system disorders are rarely treated in this way (eight use reports for respiratory tract illnesses). The lack of dermatological problems is understandable—these ailments are treated mainly by the external application of medicinal plants.Figure 5
Medicinal categories, including body systems, for which medicinal plants are used together with the yerba mate beverage.The illnesses treated with the highest number of species are digestive problems (Figure6). On one hand, emerging illnesses and symptoms such as hypertension, diabetes, and high levels of cholesterol are among the most important health problems treated with plants and yerba mate beverage. On the other hand, old humoral imbalances such as “hot” and “cold” syndromes and blood cleansing—another Hippocratic concept—are treated in this way. Other illnesses treated with a relatively high number of plants are urinary and kidney infections, heart problems, and nervous tension and finally menstrual problems related to women’s reproductive health.Figure 6
Particular illnesses treated with the highest number of species.Blood cleansing is an old concept, widely used by the Paraguayan people. According to informants, it is desirable to clean the blood periodically from impurity and to make it more fluid—thick blood is considered a symptom of illness. Medicines used for high levels of cholesterol and diabetes mellitus type 2 act on a similar conceptual basis as blood cleansers for the Paraguayan people. Therefore, my working hypothesis was that, due to this conceptual similarity, Paraguayan people would adopt plants used for blood cleansing to treat new illnesses: diabetes and high levels of cholesterol. This assumption turned out to be wrong, as informants clearly distinguished the differences between these three health problems (though all concentrated in the blood). Actually, the similarities of plants used for blood cleansing and diabetes are at 19% and for blood cleansing and high levels of cholesterol are at 32% and between diabetes and high levels of cholesterol are at 52%, meaning that if any cluster of plants exists, it only occurs between diabetes and high levels of cholesterol. Diabetes, of these three health problems, is treated with the greatest number of plants. Seventeen different species (29 UR) have been reported, but most of them were cited by single respondents, with onlySmallanthus conatus andSorocea bonplandii mentioned by 4 participants. Blood cleansing is treated with 15 medicinal plants (40 use reports) and there is much more consensus on the use of some of these species, compared with diabetes. Two species especially may be distinguished:Maytenus ilicifolia (15 UR) andAristolochia triangularis (10 UR). High levels of cholesterol have a shorter trajectory of being treated with medicinal plants than blood cleansing but longer than diabetes. There are 10 species (28 UR) used to treat high levels of cholesterol, but two of them were most often reported:Sorocea bonplandii (9 UR) andMaytenus ilicifolia (7). This comparison of the consistency of/consensus on used plants is yet another point in favour of the idea that Paraguayan people are in a constant search for adequate medicinal plants to treat diabetes and, to a lesser extent, high levels of cholesterol.Another cluster of illnesses and corresponding plants used with yerba mate extract I expected to be observed was composed of heart problems, nervous tension, and hypertension. However, the results confirm this assumption only partly, which may be due to the uneven number of species used in the treatment of hypertension (19 species), heart problems (9), and nervous tension (9). The greatest similarity was between heart problems and nervous tension at 44%. Three introduced species were used to treat these three health problems: lemon grass, mint, and rosemary.Similarities can be observed between plants used for kidney and urinary infections: seven different species are used for both health conditions (58% of similarity), of which the most important ones areBauhinia microstachya,Equisetum giganteum, andPhyllanthus niruri.


### 3.4. Forms of Administration

There is a certain pattern to the administration of plants withmate andtereré in respect to the illnesses that are treated.Mate is a vehicle to ingest hot remedies (for “cold” syndrome) and plants which treat women’s health conditions (vaginal discharge, menstrual regulation, and pregnancy prophylaxis). The convergence of plants used in both cases is at 50%. In five cases these are “hot” remedies such asAristolochia triangularis,Lippia alba,Malva parviflora,Matricaria chamomilla, andSida cordifolia used in both categories. Interestingly all panacea plants are employed with the hotmate drink, exceptVerbenaspp. On the other hand, refreshing plants (for “hot” syndrome) are prepared withtereré. Most species used for urinary infections and kidney problems are used withtereré too. However, the similarity in these two medicinal categories: refreshing plants and urinary/kidney problems is very low, at 13%, which means that in both cases quite different plants are prepared together with thetereré. Schmeda-Hirschmann and Bordas [23] also observed that Paraguayan folk medicine recognizes “hot” and “cold” remedies, whose uses dictate the manner of preparation and administration, namely, either inmate or intereré.According to Goyke [26], some plants are associated with either the hot or the cold version because of their flavour. Bitter and sharp flavours such as wormwood andanís are preferred in hot drinks while smooth flavours like mint, lemon grass, and saffron are preferred with the cold version [26]. Among 97 medicinal plants used by Paraguayan migrants with the yerba mate beverage, 23 are distinguished by their specific flavour (some of them contain essential oils) or taste (bitter, sour, or sweet). Fourteen of these plants are used withmate, five withtereré, and four with both. Bitter and sharp flavoured plants are used more often in mate, for example,Artemisia absinthium,Baccharis trimera andB.gaudichaudiana,Dysphania ambrosioides,Ruta chalepensis,orTagetes minuta. However, bitter plants are also used withtereré:Hypochaeris chillensis,Lactuca virosa, andVerbena spp. Sour tasting plants are used only withtereré, for example,Begonia cucullata.


## 3.1. Social and Medicinal Context of DrinkingMate andTereré

The sources describe four different forms of drinking processed minced leaves and stems of yerba mate [10], but the representatives of the Paraguayan community in Misiones use two basic forms of ingesting it—a hot version calledmate and a cold one:tereré. In general terms,mate is drunk all the year round, usually in the morning and in the afternoon. On hot summer days the afternoonmate may be replaced bytereré. Additionally,tereré may be drunk at noon, before lunch, and during the summer (December–March). On a few occasions, male informants mentioned that they would drinktereré the whole year round, independently of the weather. These observations stay in line with reports from rural areas of Paraguay [23, 26].The hot beverage,mate, is normally prepared in a gourd (Lagenaria spp.) also calledmate. A metal straw,bombilla, is used to ingest the extract. Industrialized yerba mate is always chosen, preferably the one with stems(con palo). According to the informants, such yerba mate does not wash away rapidly and less powder is ingested, compared to yerba mate without stems(sin palo). Small amounts of hot water (77–80°C) are repeatedly poured over a serving, ca. 50 g of packed processed yerba mate. Yerba mate may be poured from a thermos or directly from a steel kettle. The second method normally takes place in the kitchen with a stove, where the kettle can be heated up.The cold beverage—tereré—is drunk virtually from any container. Normally plastic, metal, or glass cups are used or those made from bamboo-like plants (Chusquea spp.). A metal or bamboobombilla is used. Another bigger container is filled with cold water and some other additives (Figure 2). In this case, industrially processed yerba mate is also used, but there is alsoyerba canchada—especially processed for drinkingtereré, in which leaves are crushed into large pieces.Figure 2
Tereré withkokû leaves(Allophylus edulis) prepared for a noon round on a hot summer day (Piray Km 18, Puerto Piray Municipality, Misiones, 2014).The medicinal plants used withmate are placed in a thermos or in the gourd. Whenever hard plant parts are used, such as bark or roots, they are placed in a thermos with hot water or in a kettle. Leaves, stems, and flowers are placed directly in the gourd with yerba mate. Some Paraguayans also add sugar tomate—a spoonful is added to the yerba mate every round or every second round (themate server starts from her/himself and then pours water into a gourd for each person in a clockwise order). When thetereré is prepared, all the medicinal plants are placed in a container with cold water, and sometimes ice is added. If time permits, plants are left for several minutes to macerate. Sometimes the maceration process is accelerated, by squeezing leaves in the hands to stimulate the release of juices into the water. I have never, however, observed the use of mortars to crush medicinal plants before adding them to cold water in order to prepare the medicinal maceration fortereré—something widely practiced in Paraguayan cities, for example, Asunción and Encarnación (Figure 3).Figure 3
Medicinal plants, additives totereré, and mortars in the Asunción market.Drinking yerba mate is social behaviourpar excellence. People avoid drinkingmate ortereré on their own. The afternoonmate, especially, is shared with family, neighbours, friends, and other visitors. Sometimes the addition of medicinal plants is negotiated among the participants, and in other situations the invited persons ingest the plants which the host is currently drinking with his/her yerba mate. Of anecdotal character is the story told by local doctors that Mestizo women (not necessarily of Paraguayan origin) in Misiones would add contraceptive pills tomate and then drink it with family and relatives.Yerba mate itself is not perceived as a medicinal plant by the study community. Just one person mentioned its sole use as medicinal. Nor is it conceived as a nutraceutical ingredient; at least this was never expressed explicitly by informants. Hence, it is the medicinal plants, used together withmate ortereré, that determine the medicinal properties of a yerba mate beverage. Occasionally, plants are used to improve the taste or give a flavour to yerba mate without clear medicinal cues; rosemary(Rosmarinus officinalis), mint (Mentha spp.), and lemon grass(Cymbopogon citratus) are used in this way. The importance of the yerba mate beverage as a vehicle for medicinal plants intake was also reported in another study from Paraguay. Goyke [26] stated that, for all the top scoring plants, yerba mate was either the typical or the exclusive way people consumed them. This shows how important yerba mate is medicinally, though not by its own virtue. In this sense, these findings differ from what is reported in pharmacological literature [7].Some epidemiological studies have reported an association between the consumption of yerba mate and increased risk of various types of cancer, including oral, laryngeal, and bladder cancer [7, 45, 46]. During my field campaign in 2014 this message was spread by radio, television, and newspapers to the general audience in Argentina. Information about the potential carcinogenic effects of drinking yerba mate produced serious concern among informants about the future of their habit. Nonetheless, the subsequent message that spread rapidly among them was that drinkingmate too hot might produce cancer, which was heard with deep relief.


## 3.2. Characteristics of Plants Used withMate andTereré

The Paraguayan community in Misiones uses 97 medicinal plant species (552 UR) together withmate (58 species),tereré (17), or both (22) (Table 1). Of these 97 species, 63 are native, 30 introduced, and four naturalized. Most of the plants come from cultivation (43), followed by species gathered from the wild (39); however 12 species have been reported as cultivated by some informants and collected from ruderal areas by others. Only four species were purchased in the market or from Paraguayan ambulatory sellers—women who bring plant for sale from Paraguay through the border on the Parana River.Table 1
List of medicinal plants used withmate and tereré beverages by Paraguayan migrants living in Misiones, Argentina.
Botanical name Local name Plant part used Medicinal use Mode of administration Status Number of use reports Relative importance (RI) Index of Agreement on Species (IAS) Acanthospermum australe (Loefl.) Kuntze, Asteraceae, CTES0049658 Tapekue Leaves, aerial parts Ulcers, digestion problems In mate Native 5 13 0,75  Achyrocline flaccida (Weinm.) DC. Asteraceae, CTES0032301; Achyrocline tomentosa Rusby, Asteraceae, CTES0049806 Marcela, jate’i ka’a Flower Digestion problem, stomach ache, hot remedy In mate Native 17 26,5 0,875  Acrocomia aculeata(Jacq.) Lodd. ex Mart.,Arecaceae Coco Leaves Hypertension, digestion problem In tereré Native 3 18,5 0,5  Allophylus edulis(A.St.-Hil., A. Juss. & Cambess.) Radlk., Sapindaceae, CTES0026306 Kokû Leaves Cold remedy, digestion problem, heartburn, hapatitis, blood cleansing, hypertension, hangover, prophylactic In tereré Native 34 64,5 0,74  Aloe arborescens Mill.,Xanthorrhoeaceae Aloe de hoja angosta Leaves Cancer, heart problem In mate Introduced 3 18,5 0,5  Aloysia citriodora Palau, Verbenaceae, CTES0026156 Cedrón Leaves Heart problem In mate Native 1 9,5 0  Aloysia gratissima (Gillies & Hook.) Tronc., Verbenaceae, CTES0049841 Poleo de palo Leaves Digestion problem In mate Native 1 9,5 0  Aloysia polystachya(Griseb.) Moldenke, Verbenaceae, CTES0032292 Burrito Leaves Digestion problem, stomach ache, hypertension, prophylactic In mate Native 12 32 0,72  Aloysia pulchra(Briq.) Moldenke, Verbenaceae, CTES0049842 Poleo Leaves Infecctions In mate Native 1 9,5 0  Anethum graveolensL., Apiaceae, BA92101 Eneldo Seeds Digestion problem, stomach ache In mate Introduced 2 13 0  Annona muricata L., Annonaceae Graviola Leaves Cancer In mate Introduced 2 9,5 1  Aristolochia triangularis Cham., Aristolochiaceae, CTES0026276 Ysypo milhombre(s) Liana Blood cleansing, urinary infection, hypertension, cramps, abortive, contraceptive, restores menstruation, venereal disease, digestion problem, infections, internal cold, rheumatism, cure-all, prophylactic In mate Native 28 100 0,55  Artemisia absinthiumL., Asteraceae, CTES0030264 Ajenjo Leaves Stomach ache, digestion problem, diabetes, cure-all In mate Introduced 10 30 0,67  Baccharis gaudichaudiana DC., Asteraceae, CTES0026286 Chirca melosa Leaves Blood cleansing, digestion problem, stomach ache In mate Native 3 22,5 0  Baccharis trimera(Less.) DC., Asteraceae, CTES0032297 Jaguarete ka’a, carqueja Leaves Digestion problem, stomach ache, diabetes, high level of cholesterol, blood cleansing, hangover In mate Native 19 50,5 0,72  Bauhinia forficataLink, Fabaceae, CTES0049618 Pata del buey Leaves Kidney infection In mate and tereré Native 2 9,5 1  Bauhinia microstachya(Raddi) J.F.Macbr., Fabaceae, CTES0032148 Ka’i escalera, pata del buey’i Liana Urinary infection, liquid retention, diabetes In mate and tereré Native 7 22,5 0,67  Begonia cucullata Willd., Begoniaceae, BA92089 Agrial Leaves Aphtha In tereré Native 1 9,5 0  Bidens pilosaL., CTES0049811, Bidens subalternansDC., Asteraceae, CTES0026269 Amor seco, picón Aerial parts Prostate, diabetes, hot remedy In mate Native 3 28 0  Boerhavia diffusa L., Nyctaginaceae, CTES0055777 Ka’arurupe Aerial parts Stomach ache In tereré Introduced 1 9,5 0  Campomanesia sp., Myrtaceae, CTES0049691 Yva hái mi Tree bark Diabetes In mate Native 1 9,5 0  Campomanesia xanthocarpa(Mart.) O.Berg, Myrtaceae, CTES0055662 Guavira Leaves Diarrhea In mate Native 1 9,5 0  Cecropia pachystachyaTrécul, Urticaceae, CTES0032286 Amba’y Leaves, young shoots Cough, bronchitis, rheumatism, gastritis In mate Native 5 31,5 0,25  Cissus verticillata (L.) Nicolson & C.E.Jarvis, Vitaceae, CTES0055762 Insulina Leaves Diabetes In mate Native 2 9,5 1  Citrus × aurantium L., Rutaceae, CTES0032134 Apepu Leaves, fruit Nervous tension, high level of cholesterol In mate and tereré Naturalized 2 18,5 0  Citrus reticulataBlanco, Rutaceae, CTES0032133 Mandarina Leaves Cold sore In mate Introduced 1 9,5 0  Citrus sinensis (L.) Osbeck, Rutaceae, CTES0032133 Naranja Leaves Nervous tension, headache, hypertension In mate Introduced 5 27,5 0,5  Croton sp., Euphorbiaceae, CTES0049687 Sangre de grado Tree bark Diabetes, lack of appetite In mate Native 2 18,5 0  Cyclospermum leptophyllum (Pers.) Sprague, Apiaceae, CTES0049517 Apio’i Aerial parts Cold remedy, hangover, cold sore In tereré Native 5 22,5 0,5  Cymbopogon citratus(DC.) Stapf, Poaceae, CTES0048733 Cedrón Leaves Heart problems, nervous tension, hypertension, digestion problems, prophylactic In mate and tereré Introduced 20 41 0,79  Cynodon dactylon(L.) Pers., Poaceae, CTES0025340 Gramilla Root Liquid retension In tereré Native 1 9,5 0  Dolichandra unguis-cati(L.) L.G. Lohmann, Bignoniaceae, CTES0049524 Uña de gato Rhizome Kidney infection, urinary problems, cold remedy In tereré Native 5 18,5 0,5  Dysphania ambrosioides(L.) Mosyakin & Clemants, Amaranthaceae, CTES0032130 Ka’arê Leaves Hot remedy In mate Introduced 3 9,5 1  Elionurus muticus(Spreng.) Kuntze, Poaceae, CTES0026294 Kapi’i cedrón Leaves Nervous tension In mate Native 1 9,5 0  Equisetum giganteumL., Equisetaceae, CTES0049521 Cola de caballo Leaves Kidney infection, urinary problems, liquid retention, kidney stones In mate and tereré Native 12 20,5 0,72  Eriobotrya japonica(Thunb.) Lindl., Rosaceae, CTES0032147 Níspero Leaves, young shoots Hypertension, all-cure In mate and tereré Introduced 2 18,5 0  Eugenia pyriformis Cambess. var. pyriformis, Myrtaceae, CTES0048743 Yva hái Leaves Diabetes, hypertension, high level of cholesterol In mate and tereré Native 7 18,5 0,66  Eugenia unifloraL., Myrtaceae, CTES0026288 Ñangapiry, pitanga Leaves Hypertension, cold remedy In mate and tereré Native 11 18,5 0,82  Euphorbia prostrata Aiton, Euphorbiaceae Tupasy kamby Aerial parts Liquid retension, blood cleansing In mate Native 2 18,5 0  Euphorbia serpensKunth, Euphorbiaceae, CTES0026291 Tupasy kamby Aerial parts Cold remedy, vaginal discharge In mate Native 2 18,5 0  Foeniculum vulgareMill., Apiaceae, CTES0049511 Aipo, hinojo Aerial parts Muscle pains, overheated stomach In mate and tereré Introduced 2 18,5 0  Gleditsia amorphoides (Griseb.) Taub., Fabaceae, CTES0026088 Ñuatî kurusu Tree bark Hypertension, infection In mate Native 2 18,5 0  Gomphrena celosioidesMart. f.roseiflora(Chodat & Hassl.) Pedersen, Amaranthaceae, CTES0055763 Perudilla Aerial parts Cold remedy, cold sore In tereré Native 4 13 0,67  Guarea macrophylla Vahl subsp.spiciflora (A. Juss.) T.D. Penn., Meliaceae, CTES0026272 Cedrillo Trunk Inernal jab and wound In mate and tereré Native 3 9,5 1  Gyneriumspp., Poaceae Caña brava Root Blood cleansing In mate Native 1 9,5 0  Hemionitis tomentosa(Lam.) Raddi, Pteridaceae, CTES0049653 Doradilla Leaves Vaginal discharge, irregular menstruation, bladder infection, blood cleansing In mate Native 4 31,5 0  Heteropterys glabraHook & Arn., Malpighiaceae, CTES0026280 Tilo Leaves, flower Heart problem, nervous tension In mate Native 2 18,5 0  Hypochaeris chillensis (Kunth) Hieron., Asteraceae, CTES0026099 Achicoria silvestre Root, leaves Cold remedy In tereré Native 6 9,5 1  Jacaranda micrantha Cham., Bignoniaceae, CTES0026265 Karoba Tree bark Blood cleansing, cure-all In mate Native 7 18,5 0,83  Jacaratia spinosa(Aubl.) A.DC., Caricaceae, CTES0032144 Jakarati’a Leaves Hypertension In mate Native 1 9,5 0  Lactuca virosa Habl., Asteraceae, CTES0030265 Lechuga japonesa Leaves Hypertension In tereré Introduced 1 9,5 0  Lippia alba (Mill.) N.E.Br. ex Britton & P.Wilson, Verbenaceae,BA92110 Salvia Leaves, flower Menstrual pain, stomach pain, hot remedy, prophylactic, all-cure In mate Native 8 50,5 0,43  Lippia brasiliensis (Link) T.R.S. Silva, Verbenaceae, CTES0049516 Jate’i ka’a ka’aguy Leaves Abdomen pain, hot remedy, prophylactic In mate Native 3 28 0  Malva parviflora L., Malvaceae, CTES0049514 Malva de castilla Leaves Prophylactic during pregnancy, hot remedy In mate Introduced 2 18,5 0  Mangifera indica L., Anacardiaceae Mango Leaves, seed Hypertension, constipation In mate and tereré Introduced 4 18,5 0,67  Matricaria chamomilla L., Asteraceae, CTES0026285 Manzanilla Inflorescence Menstrual pain, stomach pain, hot remedy, infections, prophylactic In mate Introduced 9 50,5 0,5  Maytenus ilicifolia Mart. ex Reissek, Celastraceae, CTES0048746 Kangorosa Leaves, root, bark Blood cleansing, high level of cholesterol, hypertension, internal infections, ulcers, abdomen pain, urinary infection, hot remedy In mate Native 30 77 0,76  Melilotussp., Fabaceae Alfalfa Aerial parts Rheumatism, eye problem In mate and tereré Introduced 2 18,5 0  Melissa officinalis L., Lamiaceae, CTES0032129 Toronjil Leaves Heart problem, cold remedy In mate and tereré Introduced 2 18,15 0  Menthasp., Lamiaceae [Mentha spicata L. CTES0030909] Menta, menta’i Leaves Nervous tension, heart problem, hypertension, headache, intestinal problems, abdomen pain, hot remedy, cold remedy, yerba mate additive In mate and tereré Introduced 16 58,25 0,53  Moringa oleifera Lam., Moringaceae, CTES0049652 Moringa Leaves Diabetes, high level of cholesterol, cancer, ulcers, digestion problem, kidney infection, urinary problem, prophylactic, all-cure In mate and tereré Introduced 15 69,25 0,43  Morus alba L., Moraceae, CTES0049525 Mora Leaves Hypertension, excessive libido In mate and tereré Introduced 2 18,5 0  Myrocarpus frondosus Allemao, Fabaceae Incienso Tree bark Ulcers In mate Native 1 9,5 0  Ocimum cf.basilicum var.anisatum Benth, Lamiaceae, CTES0030915 Anís Leaves Prophylactic In mate Introduced 3 18,5 1  Panicum tricholaenoides Steud., Poaceae, CTES0032493 Cola de caballo Leaves Kidney infection In mate and tereré Native 2 9,5 1  Parietaria debilis G. Forst., Urticaceae, CTES0055778 Ka’a piky Aerial parts Cold remedy, cold sore, nervous tension, In tereré Native 14 31,5 0,85  Parietaria judaica L., Urticaceae, CTES0049674 Buscapina Leaves Digestion problem In mate Introduced 1 9,5 0  Passiflora alata Curtis, Passifloraceae, CTES0032140 Mburukuja Leaves Nervous tension In tereré Native 1 9,5 0  Peperomia circinnataLink, Piperaceae, CTES0049675 Jatevu ka’a Entire plant Hypertension In tereré Native 2 9,5 1  Persea americana Mill., Lauraceae Palta Seeds Kidney infection In mate Naturalized 1 9,5 0  Persea americana var. drimyfolia(Cham. & Schltdl.) S.F.Blake, Lauraceae, BA92058 Palta anís Leaves Heart problem, liver problem, cold remedy In mate and tereré Naturalized 3 28 0  Petroselinum crispum (Mill.) Fuss, Apiaceae, CTES0049501 Perejíl Leaves Cold remedy In tereré Introduced 1 9,5 0  Phyllanthus niruri L., Phyllanthaceae, CTES0026299 Rompepiedras, quebrapiedra, para’parai Aerial parts Kidney infection, urinary problems, liquid retention In mate and tereré Native 7 17 0,67  Piper mikanianum (Kunth) Steud., Piperaceae, CTES0032289 Pariparoba Leaves Heart problem, abdomen pain, hot remedy In mate Native 5 28 0,5  Plantago australis Lam., Plantaginaceae,BA92072 Llantén Leaves Flu, sore throat, infections, cold sore, blood cleansing, prophylactic, cure-all In mate Native 10 54,5 0,33  Pluchea sagittalis Less., Asteraceae, CTES0048748 Yerba del lucero Leaves Digestion problem In mate Native 1 9,5 0  Rollinia salicifolia Schltdl., Annonaceae, CTES0026257 Aratiku Leaves, flower Hypertension, diabetes In mate Native 4 18,5 0,67  Rosa sp., Rosaceae, CTES0049673 Rosa Flower Constipation In mate Introduced 1 9,5 0  Rosmarinus officinalis L., Lamiaceae, CTES0049845 Romero Leaves Heart problem, nervous tension, abdomen pain, stomach pain, high level of cholesterol, hypertension, blood cleansing, hot remedy, headache, imporves memory, prophylactic, all-cure, yerba mate additive In mate Introduced 32 84,5 0,65  Ruta chalepensis L., Rutaceae, CTES0026289 Ruda Leaves Sore throat, prophylactic In mate Introduced 3 18,5 0,5  Scoparia dulcis L., Plantaginaceae, CTES0049830 Typycha kuratû Aerial parts Digestion problem, stomach ache, diabetes In mate Native 3 22,5 0  Sechium edule (Jacq.) Sw., Cucurbitaceae, CTES0026263 Chuchu, xuxu Leaves Hypertension In mate Naturalized 1 9,5 0  Sida cordifolia L., Malvaceae, CTES0026266 Malva blanca Leaves, flower Vaginal discharge, vaginal infection, irregular menstruation, menstrual pain, prophylactic during pregnancy, hot remedy, blood cleansing, kidney infection, urinary problem In mate Native 19 62 0,55  Smallanthus connatus (Spreng.) H.Rob., Asteraceae, CTES0049444 Jaguarete po Leaves Diabetes, high level of cholesterol, stomach ache In mate and tereré Native 7 28 0,67  Solanum sisymbriifolium Lam., Solanaceae, CTES0032288 Ñuatî pytâ Root Urinary infection In tereré Introduced 1 9,5 0  Solidago chilensis Meyen,Asteraceae, CTES0049655 Teju ka’a, yerba del lagarto Aerial parts Prophylactic In mate Native 1 9,5 0  Sorocea bonplandii (Baill.) W.C. Burger, Lanj.&Wess. Boer, Moraceae, CTES0026282 Ñandypa Root, leaves High level of cholesterol, diabetes, obesity, blood cleansing In mate Native 15 32 0,78  Stachytarpheta cayennensis(Rich.) Vahl, Verbenaceae, CTES0055765 Tatu ruguái, verbena tatu ruguái Aerial parts Prostate, male aphrodisiac In mate and tereré Native 2 13 0  Stevia rebaudiana (Bertoni) Bertoni, Asteraceae, CTES0049664 Ka’a he’ê Leaves Heartburn, diabetes, prophylactic In mate Native 4 28 0,33  Styrax leprosus Hook. & Arn., Styracaceae, CTES0026167 Carne de vaca Tree bark Diabetes, high level of cholesterol In mate Native 4 18,5 0,67  Tabernaemontana catharinensis A.DC., Apocynaceae, CTES0049506 Horquetero Leaves Diabetes, high level of cholesterol In mate Native 2 18,5 0  Tagetes minuta L., Asteraceae, CTES0026292 Suico Leaves, flower Intestinal parasites, empacho (folk illness) In mate Native 2 18,5 0  Tanacetum parthenium (L.) Sch. Bip., Asteraceae, CTES0049661 Manzanilla guasu Flower Stomach ache In mate Introduced 1 9,5 0  Urera baccifera (L.) Gaudich. ex Wedd., Urticaceae, CTES0026278 Ortiga grande Root Urinary problem, liquid retension, blood cleansing In tereré Native 4 22,5 0,33  Verbena litoralis Kunth, Verbenaceae, CTES0026305;Verbena montevidensis Spreng.,Verbenaceae, BA92064 Verbena Leaves Stomach ache, digestion problem, lack of appetite, fever, diabetes, cold remedy, blood cleansing, hangover, headache, cure-all In tereré Native 18 66 0,59  Xanthium spinosum L., Asteraceae, CTES0049666 Cepacaballo, abrojito Leaves Digestion problem, liver problem, cold remedy In mate and tereré Introduced 3 22,5 0  Zea mays L., Poaceae Barba de choclo Flower Urinary problem In mate Introduced 2 9,5 1Allophylus edulis,kokû, is the plant with the highest number of citations (30) and UR (34) (Figure 4). It is used only withtereré and is a “cold” remedypar excellence for Paraguayan people. It is also widely used in the treatment of digestive tract illnesses, hepatitis, and hypertension. Some pharmacological properties of this species are known, which largely coincide with the folk use, according to whichA.edulis acts as a hepatoprotector (flavonoids) and angiotensin converting enzyme (ACE) inhibitor [47].Figure 4
Species with the highest number of citations and relative importance value.The most versatile plant species (with the highest RI value) isAristolochia triangularis,ysypo milhombre(s). This species is only applied inmate. It is used in the treatment of nine different categories, the most important being humoral medicine (blood cleansing), but also urinary (infections) cardiovascular (hypertension), reproductive, digestive, and musculoskeletal (rheumatism) systems, and for general infections. Its use in the reproductive health category is unclear. For some informants,A. triangularis is a contraceptive or an abortifacient agent, when used in greater doses, and for others it cures venereal diseases and enhances male potency—this latter information is inscribed in the plant nameysypo [liana]milhombre(s) [thousand-men]. All informants agreed that it should be used with caution; however they could not explain what the exact side effects might be. Given its popularity among the Paraguayan community, there is surprisingly little information published on the folk medicinal use ofA.triangularis, just two reports from Argentina [48, 49], one from Brazil [50], and a few general ones from South America [51]. The only pharmacologically tested properties found so far are cytotoxic [49]. The known chemical compounds are alkaloids, essential oils, lignans, terpenoids, saponins, tannins, and aristolochic acids (AAs) [52–54]. In the ethnopharmacological review by Heinrich et al. [51], differentAristolochia spp. were described, includingA.triangularis. Since it also contains aristolochic acids, the consumption of the species poses a risk. In China and Europe species ofAristolochiahave been associated with nephropathy, but there is a lack of data about the potential risk of renal toxicity from consuming AAs in South American literature [51].The species with the highest consistency and consensus on use, measured by Index of Agreement on Species (IAS), were those with just one use mentioned by two or three respondents. One of the taxa with a parallel high number of citations and IAS score wasAchyrocline spp. There are two species used indiscriminately within this genus:Achyrocline flaccidaandAchyrocline tomentosacalledjate’i ka’a andmarcela. These taxa are used for digestion problems and as “hot” remedy and they are always applied inmate by Paraguayan people. The importance ofAchyrocline species in Paraguayan folk medicine was already highlighted by Schmeda-Hirschmann and Bordas [23]. According to pharmaceutical studies,A.flaccidapossesses antiviral and antibacterial activity [55, 56]. It contains caffeoyl derivatives, essential oils, flavonoids, and sesquiterpenes [57]. Phytochemical studies ofA.tomentosa reported the presence of flavonoids as well as 27 mayor and trace elements [58, 59].Other species from the list of the most cited ones and with the highest RI value, include native plants such asMaytenus ilicifolia,Baccharis trimera,Sida cordifolia, andVerbena litoralis/Verbena montevidensis—used indiscriminately. All of them have been studied phytochemically [60]. There are also four introduced plants on this list, all of them well studied:Rosmarinus officinalis,Cymbopogon citratus, andMentha spp. with a long tradition of use andMoringa oleifera which has only recently (in the last 5-6 years) been incorporated by Paraguayan migrants in Misiones.How many antidiabetic properties can be found in the plants used to treat diabetes by Paraguayan people? The study community uses 17 different plant species withmate andtereréto treat diabetes mellitus type 2. From this group onlyMoringa oleifera [61, 62] andScoparia dulcis [63] have been confirmed to possess antidiabetic properties. Interestingly, Paraguayan migrants, through their family and friendship channels, obtain seedlings ofCissus verticillata andSmallanthus connatus from Paraguay, as potent antidiabetic plants.C.verticillata is calledinsulina by them; however so far only antifungal activity has been ascribed to this species [64]. Therefore, only a small portion of the plants used as antidiabetic by Paraguayan people have been proven to possess pharmacologically tested properties for diabetes. Most probably the pharmacological action in the treatment of this health problem may be ascribed directly toIlex paraguariensis, while informants see it in the properties of medicinal plants used with yerba mate. The question here may be whether medicinal plants with pharmacologically tested antidiabetic properties have an additive or synergetic function in the beverage.A similar question was posed in the context of hypertension—another chronic problem for which the Paraguayan community in Misiones uses 19 different species. From this list, onlyEugenia uniflora has been assigned clear hypotensive activity [65, 66]. Indeed, this species is applied inmate andtereré with the highest frequency, with the function of decreasing blood pressure.These two health problems have been incorporated into phytotherapy most recently by the Paraguayan people, and comparison with the pharmaceutical literature shows that Paraguayan people are still in the process of using trial-and-error to find adequate herbal medicines, efficacious in the treatment of these health conditions. The relatively high number of species used for these events also indicates a personalistic approach to the search for the right drug.


## 3.3. Characteristics of Illnesses Treated with Mixtures Based on the Yerba Mate Beverage

Medicinal plants are used for their preventive and curative properties. The scope of illnesses treated with medicinal plants used inmate andtereré is very wide. Eighteen use categories have been reported, including 10 body systems (Figure 5). The most important categories are digestive, followed by humoral medicine, cardiovascular, endocrinological, and urinary categories. Interestingly, respiratory system disorders are rarely treated in this way (eight use reports for respiratory tract illnesses). The lack of dermatological problems is understandable—these ailments are treated mainly by the external application of medicinal plants.Figure 5
Medicinal categories, including body systems, for which medicinal plants are used together with the yerba mate beverage.The illnesses treated with the highest number of species are digestive problems (Figure6). On one hand, emerging illnesses and symptoms such as hypertension, diabetes, and high levels of cholesterol are among the most important health problems treated with plants and yerba mate beverage. On the other hand, old humoral imbalances such as “hot” and “cold” syndromes and blood cleansing—another Hippocratic concept—are treated in this way. Other illnesses treated with a relatively high number of plants are urinary and kidney infections, heart problems, and nervous tension and finally menstrual problems related to women’s reproductive health.Figure 6
Particular illnesses treated with the highest number of species.Blood cleansing is an old concept, widely used by the Paraguayan people. According to informants, it is desirable to clean the blood periodically from impurity and to make it more fluid—thick blood is considered a symptom of illness. Medicines used for high levels of cholesterol and diabetes mellitus type 2 act on a similar conceptual basis as blood cleansers for the Paraguayan people. Therefore, my working hypothesis was that, due to this conceptual similarity, Paraguayan people would adopt plants used for blood cleansing to treat new illnesses: diabetes and high levels of cholesterol. This assumption turned out to be wrong, as informants clearly distinguished the differences between these three health problems (though all concentrated in the blood). Actually, the similarities of plants used for blood cleansing and diabetes are at 19% and for blood cleansing and high levels of cholesterol are at 32% and between diabetes and high levels of cholesterol are at 52%, meaning that if any cluster of plants exists, it only occurs between diabetes and high levels of cholesterol. Diabetes, of these three health problems, is treated with the greatest number of plants. Seventeen different species (29 UR) have been reported, but most of them were cited by single respondents, with onlySmallanthus conatus andSorocea bonplandii mentioned by 4 participants. Blood cleansing is treated with 15 medicinal plants (40 use reports) and there is much more consensus on the use of some of these species, compared with diabetes. Two species especially may be distinguished:Maytenus ilicifolia (15 UR) andAristolochia triangularis (10 UR). High levels of cholesterol have a shorter trajectory of being treated with medicinal plants than blood cleansing but longer than diabetes. There are 10 species (28 UR) used to treat high levels of cholesterol, but two of them were most often reported:Sorocea bonplandii (9 UR) andMaytenus ilicifolia (7). This comparison of the consistency of/consensus on used plants is yet another point in favour of the idea that Paraguayan people are in a constant search for adequate medicinal plants to treat diabetes and, to a lesser extent, high levels of cholesterol.Another cluster of illnesses and corresponding plants used with yerba mate extract I expected to be observed was composed of heart problems, nervous tension, and hypertension. However, the results confirm this assumption only partly, which may be due to the uneven number of species used in the treatment of hypertension (19 species), heart problems (9), and nervous tension (9). The greatest similarity was between heart problems and nervous tension at 44%. Three introduced species were used to treat these three health problems: lemon grass, mint, and rosemary.Similarities can be observed between plants used for kidney and urinary infections: seven different species are used for both health conditions (58% of similarity), of which the most important ones areBauhinia microstachya,Equisetum giganteum, andPhyllanthus niruri.


## 3.4. Forms of Administration

There is a certain pattern to the administration of plants withmate andtereré in respect to the illnesses that are treated.Mate is a vehicle to ingest hot remedies (for “cold” syndrome) and plants which treat women’s health conditions (vaginal discharge, menstrual regulation, and pregnancy prophylaxis). The convergence of plants used in both cases is at 50%. In five cases these are “hot” remedies such asAristolochia triangularis,Lippia alba,Malva parviflora,Matricaria chamomilla, andSida cordifolia used in both categories. Interestingly all panacea plants are employed with the hotmate drink, exceptVerbenaspp. On the other hand, refreshing plants (for “hot” syndrome) are prepared withtereré. Most species used for urinary infections and kidney problems are used withtereré too. However, the similarity in these two medicinal categories: refreshing plants and urinary/kidney problems is very low, at 13%, which means that in both cases quite different plants are prepared together with thetereré. Schmeda-Hirschmann and Bordas [23] also observed that Paraguayan folk medicine recognizes “hot” and “cold” remedies, whose uses dictate the manner of preparation and administration, namely, either inmate or intereré.According to Goyke [26], some plants are associated with either the hot or the cold version because of their flavour. Bitter and sharp flavours such as wormwood andanís are preferred in hot drinks while smooth flavours like mint, lemon grass, and saffron are preferred with the cold version [26]. Among 97 medicinal plants used by Paraguayan migrants with the yerba mate beverage, 23 are distinguished by their specific flavour (some of them contain essential oils) or taste (bitter, sour, or sweet). Fourteen of these plants are used withmate, five withtereré, and four with both. Bitter and sharp flavoured plants are used more often in mate, for example,Artemisia absinthium,Baccharis trimera andB.gaudichaudiana,Dysphania ambrosioides,Ruta chalepensis,orTagetes minuta. However, bitter plants are also used withtereré:Hypochaeris chillensis,Lactuca virosa, andVerbena spp. Sour tasting plants are used only withtereré, for example,Begonia cucullata.


## 4. Conclusions

Yerba mate(Ilex paraguariensis) is not considered a medicinal plant by Paraguayan migrants living in Misiones, Argentina, by its own medicinal virtues. This plant, however, is culturally and medicinally a very important conveyor for medicinal plant intake. The Paraguayan community in Misiones uses 97 plant species in hot and cold versions of the yerba mate beverage. Most of the plants are native to the south cone of South America and come from cultivation.There is a certain pattern of administration of plants withmate andtereré in respect to the illnesses that are treated.Mate is a vehicle to ingest hot remedies (for “cold” syndrome) and plants which treat women’s reproductive health. Refreshing plants (for “hot” syndrome) are always prepared withtereré. Most species used for urinary infections and kidney problems are used withtereré too. Some plants are associated with either the hot or the cold version because of their flavour and taste. Bitter and sharp flavoured plants are more often used inmate. Sour tasting plants are used only withtereré.The plants are used for a wide array of medicinal categories from which the digestive system and humoral concept prevail—traditionally treated with medicinal plants. On the other hand, relatively new chronic health conditions: diabetes, hypertension, and high levels of cholesterol are also treated with a large number of species. Therefore, this traditional form of administration of medicinal plants proves to be receptive for treating new health problems. Newly incorporated medicinal plants, such asMoringa oleiferaorAnnona muricata, are applied predominantly or exclusively with themate beverage. The question which remains unanswered is whether medicinal plants with pharmacological properties similar to yerba mate have an additive or synergetic function in the beverage.



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