Medicinal plants for women's healthcare in southeast Asia: a meta-analysis of their traditional use, chemical constituents, and pharmacology

Plants used during maternity, menstrual cycle and other women's health conditions among Brazilian cultures

ETHNOPHARMACOLOGICAL RELEVANCE

For innumerous clinical cases related to women's health and precarious medical care in developing countries, a large repertoire of plants have been used as popular medicines in order to fill this gap, which in a certain way creates health risks to users, since pharmacological and toxicological tests are still insufficient to guarantee their efficacy and safety. Besides therapeutic use, abortive plants are broadly used in countries where abortion is prohibited, increasing that risk even more. In this way, ethnopharmacological studies that register plants used for women's health can contribute not only to the selection of potential bioactives, enriching the repertoire of drugs available to females, above all in public health systems, but also questioning the safety of products that are used without prescription.

AIMS AND OBJECTIVES

This review aims at determining plants applied by Brazilian cultures in the treatment of conditions related to maternity, menstrual cycle and other women's health particularities, and to supplement the lack of epidemiological data available to assess the health of indigenous, rural and other populations of Brazilian women.

MATERIALS AND METHODS

A literature review was conducted of the collection at the Ethnobotanical and Ethnopharmacological Center of the Federal University of São Paulo (period covered: 1965 to 2012). All of the 343 articles were consulted and 31 articles mentioning therapeutic uses of interest were selected. Relevant information was extracted to compose Table 1 - Maternity, Table 2 - Menstrual Cycle and Table 3 - Other Conditions. Data was statistically analyzed in order to generate the discussion about plants used in healing contexts by different Brazilian ethnicities. A bibliographic review was performed using the Scopus database to collect the following information about the most cited plants: ethnobotany/ethnopharmacology of non-Brazilian cultures for women's health conditions, pharmacology, toxicology, and adverse reactions.

RESULTS

A total of 319 species were cited for 22 indications related to women's health. Ninety-seven species were indicated for conditions related to maternity, 94 to the menstrual cycle and 232 to others. The same species could be present in more than one of these three categories. The most cited family was Fabaceae (13.5%), and the species were Ruta graveolens L. (1.76%) and Strychnos pseudoquina A. St.-Hil (1.76%). The most frequent part utilized, mode of preparation and route of administration were leaves (2.0%), tea (73.38%) and oral (87. 2%), respectively. The indications that showed the highest number of species were: to treat venereal diseases (69 species), abortive (54) and anti-inflammatory for the ovaries and/or uterus (54). According to our bibliographic survey, among the 19 most indicated species in this review, only four are also used by non-Brazilian cultures for conditions related to women's health; 25% of them were pharmacologically investigated and it was possible to validate their ethnopharmacological/ethnobotanical use, 10.5% have presented well-described adverse reactions and for 42.1% of these species toxicological studies were performed.

CONCLUSION

The survey raised important data about plants implemented in healing related to women's health conditions by Brazilian cultures and their practices. The compilation presented in this study enables the realization of further investigation regarding the development of herbal medicines and contributes to the incrementation of policies focused on these cultures. Further phytochemical, pharmacological and toxicological studies should be conducted, which will allow the discovery of pharmacological properties, bioactive constituents, and moreover, adequate posology, manner of use and adverse events.

Evaluation of DNA barcoding coupled high resolution melting for discrimination of closely related species in phytopharmaceuticals

BACKGROUND

Phytopharmaceuticals are increasingly popular as alternative medicines, but poorly regulated in many countries. The manufacturers of these products should be subject to strict controls regarding each product's quality and constituents. Routine testing and identification of raw materials should be performed to ensure that the raw materials used in pharmaceutical products are suitable for their intended use.

HYPOTHESIS/PURPOSE

We have applied DNA Barcoding - High Resolution Melting (Bar-HRM), an emerging method for identifying of medicinal plant species based on DNA dissociation kinetics and DNA barcoding, for the authentication of medicinal plant species.

STUDY DESIGN

Commonly commercialized Thai medicinal plants that are widely used for medicinal purposes were used in this study. Publicly available sequences of four plastid markers were used for universal primer design. Species discrimination efficiency of the designed primers was evaluated as single and multi-locus analyses by using the primers sets.

METHODS

HRM analysis was performed in triplicate on each of the 26 taxa to establish the Tm for each primer set (matK, rbcLA, rbcLB, rbcLC, rpoC1, and trnL). The shapes of the melting curves were analyzed to distinguish the different plant species. Bar-HRM species identification success rates were assessed for each single-locus as well as for multi-locus combinations to establish the optimal combination of primer sets.

RESULTS

In single locus analysis the rpoC1 primer set gave the highest discrimination (58%), and in multi locus analysis this could be increased from 87% to 99% depending on the total number of regions included. Different combinations proved to be more or less effective at discrimination, depending on the genus or family examined.

CONCLUSIONS

Bar-HRM has proven to be a cost-effective and reliable method for the identification of species in this study of Thai medicinal plants, and results show an identification success rate of 99% among species in the test set.

Ethnomedical research and review of Q'eqchi Maya women's reproductive health in the Lake Izabal region of Guatemala: Past, present and future prospects

ETHNOPHARMACOLOGICAL RELEVANCE

In Central America, most Maya women use ethnomedicines for all aspects of their reproductive cycle including menstruation, pregnancy and menopause. However, very few of these plants have been documented, collected and tested in appropriate pharmacological assays to determine possible safety and efficacy. The aim of this work was to provide an overview of information on the ethnomedical uses, ethnopharmacology, chemistry and pharmacological research for medicinal plants used for women's reproductive health in Guatemala, with a special emphasis on the Q'eqchi Maya of the Lake Izabal region, to demonstrate therapeutic potential and support future research in the field.

MATERIALS AND METHODS

Reviews of the ethnobotanical, ethnomedical and ethnopharmacological literature were performed for 30 plants collected in the Lake Izabal region of Guatemala and used by the Q'eqchi Maya for treatment of reproductive health issues were performed up to and including July 2015 using multiple databases, library searches for abstracts, books, dissertations, and websites.

RESULTS AND CONCLUSIONS

Review of the published research confirms that many of the plants used by Q'eqchi Maya women for the management of reproductive health issues have pharmacological activities, including analgesic, anti-inflammatory, estrogenic, progestagenic and/or serotonergic effects, that support the use of these plants and provide plausible mechanisms of action for their traditional uses. Furthermore, a new serotonin agonist, 9, 10-methylenedioxy-5, 6-Z-fadyenolide was isolated, thereby demonstrating an untapped potential for drug discovery. However, to date much of the pharmacological assays have been in vitro only, and few in vivo studies have been performed. Considering the large percentage of the Maya population in Guatemala that use traditional medicines, there remains a significant lack of pharmacological and toxicological data for these plants. Future research should focus on the safety and efficacy of medicinal plants using in vivo preclinical studies and clinical trials, as well as chemical analysis. Since medicinal plants from the Piperaceae are most commonly used as traditional medicines by the Q'eqchi Maya women, and new bioactive compounds have been identified from Piper species, investigations of commonly used plants from this family would be an appropriate place to start. Data generated from such studies would contribute to Guatemala's national effort to promote a complementary relationship between traditional Maya medicine and public health services.

In vitro antimicrobial and anti-proliferative activities of plant extracts from Spathodea campanulata, Ficus bubu, and Carica papaya

CONTEXT

African medicinal plants represent a prominent source of new active substances. In this context, three plants were selected for biological investigations based on their traditional uses.

OBJECTIVE

The antimicrobial and anti-proliferative features of three plants used for medicinal purpose were evaluated.

MATERIALS AND METHODS

The antimicrobial activities of methanol extracts of Ficus bubu Warb. (Moraceae) stem bark and leaves, of Spathodea campanulata P. Beauv. (Bignoniaceae) flowers, as well as those of Carica papaya Linn. (Caricaceae) latex, were determined using the microbroth dilution method against a set of bacteria and fungi pathogens including: Enterococcus faecalis, Staphylococcus aureus, S. saprophyticus, S. epidermididis, Escherichia coli, Klebsiella pneumonia, Salmonella typhimurium, Candida albicans, and Trichophyton rubrum. The tested concentrations of extracts ranged from 2500.0 to 2.4 μg/mL and MIC values were evaluated after 24 h incubation at 37 °C. Subsequently, MTT assay was used to estimate anti-proliferative activity of these methanol extracts and of F. bubu latex on three human cancer cell lines (U373 glioblastoma, A549 NSCLC, and SKMEL-28 melanoma).

RESULTS

The methanol extract of F. bubu stem bark exhibited the highest antimicrobial activity against C. albicans with a MIC value of 9.8 μg/mL, while the F. bubu latex and the methanol extract of F. bubu leaves induced significant anti-proliferative activity against lung (IC50 values of 10 and 14 μg/mL, respectively) and glioma (IC50 values of 13 and 16 μg/mL, respectively) cancer cells.

CONCLUSION

These results indicate that effective drugs could be derived from the three studied plants.

Attitudes and use of medicinal plants during pregnancy among women at health care centers in three regions of Mali, West-Africa

BACKGROUND

Although, medicinal plants have been important for women's health historically, the knowledge about such use during pregnancy in developing countries is limited. This is the first quantitative, ethnobotanical study on Malian women's use of and attitudes towards the use of medicinal plants during pregnancy. The aim of the study was to describe Malian women's use of medicinal plants during pregnancy according to indications and to evaluate the potentially safety of such use. The overall aim was to preserve valuable information about medicinal plants for women's reproductive health for the future.

METHODS

Data was collected through structured interviews of 209 pregnant women or mothers in three health care centers in Mali. The women were interviewed about their uses of medicinal plants during pregnancy and their attitudes to such use. Nine specific medicinal plants commonly used in Mali and treatment of eleven common ailments in pregnancy were specifically queried about.

RESULTS

In total, 79.9 % had used medicinal plants during pregnancy. Only 17 women (8.5 %) had received a recommendation from a traditional practitioner (TP). The most commonly used medicinal plants were Lippia chevalieri (55.5 %), Combretum micranthum (39.7 %), Parkia biglobosa (12.0 %) and Vepris heterophylla (8.1 %). The most common reasons for use were for well-being (37.7 %), symptoms of malaria (37.1 %) and "increased salt-elimination" (to reduce edema) (19.2 %). For treatment of symptoms of malaria and urinary tract infections during pregnancy, the women's choices of medicinal plants agreed with those previously reported from interviews with TPs. Almost 30 % believed that medicinal plants had no adverse effects for the mother.

CONCLUSION

This study showed an extensive use and knowledge of medicinal plants during pregnancy in three regions in Mali. However, exclusive use of medicinal plants as treatment of malaria and urinary tract infections during pregnancy may pose a health risk for the mother and her unborn child. A wider collaboration with TPs, with local communities and conventional health workers of the health care centers, on the safe use of medicinal plants, is important to promote safer pregnancies and better health care for pregnant women and their unborn infants in Mali.

An ethnobotanical survey of medicinal plants in Trinidad

BACKGROUND

An ethnobotanical survey was conducted on the Caribbean island of Trinidad to identify medicinal plants commonly used in traditional medicine to treat a variety of medical conditions.

METHODS

A pilot survey was conducted to identify the top ten most common ailments where medicinal plants were used. The results of the foregoing study guided a wider national survey conducted between October 2007 and July 2008. A total of 450 households from 50 rural communities were interviewed using the TRAMIL (Traditional Medicine in the Islands) questionnaire for data collection. Details of plants, part(s) used, and remedy formulations were elicited from informants and voucher specimens collected for identification at the National Herbarium of Trinidad and Tobago. The TRAMIL methodology set a limit of a plant with 20 % or more citations for any particular ailment as having significant or popular use.

RESULTS

At the end of the survey 917 single plant remedies were identified. The majority of species were from the following families; Asteraceae, Lamiaceae, Leguminosae, Verbenaceae and Poaceae. Applying the TRAMIL 20 % citation of a plant for popular use as significant, Leonotis nepetifolia (for cough/common cold), Gomphrena globosa (for "stoppage-of-water"), Curcuma longa and Senna occidentalis (for "afterbirth"), Cymbopogon citratus and Neurolaena lobata (for fever), and Citrus limon (for kidney stones) qualified in our study. Those not reaching the TRAMIL 20 % significant (popular) use were Stachytarpheta jamaicensis (L.) Vahl, Senna alata (L.) Roxb.and Momordica charantia L. which were widely used as "'cooling/cleanser'" in our survey.

CONCLUSIONS

Our survey showed significant retention of traditional knowledge of medicinal plants in rural Trinidad. More interestingly, a large remnant of medico-cultural concepts such as "cooling/cleanser", "afterbirth", "stoppage-of-water" and "womb infection" persist in the rural population. Although the scientific literature show that some of the cited plants possessed antimicrobial, anti-inflammatory and related pharmacological activities in laboratory studies, these results must be taken with caution until clinical trials are conducted to establish safety and efficacy.

Herbal Therapies and Social-Health Policies: Indigenous Ati Negrito Women's Dilemma and Reproductive Healthcare Transitions in the Philippines

The high maternal mortality in the Philippines in the past decades prompted intervention strategies to curb unwanted deaths of mothers and improve health and social conditions of women. Such introductions however have begun to challenge traditional reproductive health practices creating confusion among practitioners and incipient transitions in healthcare. Our aim in this study was to document the herbal therapies practiced by indigenous Ati Negrito women and discuss the implications of social and conventional healthcare intervention programs on reproductive healthcare traditions by conducting semistructured interviews. Fidelity Level index was used to determine culturally important plants (i.e., the most preferred). Review of related studies on most preferred plants and therapies was further carried out to provide information regarding their safety/efficacy (or otherwise). Determination of informants' traditional medicinal knowledge was done using Mann-Whitney U and Kruskal-Wallis tests. A total of 49 medicinal plants used in treating female reproductive health-related syndromes across four categories were recorded. Significant differences in traditional medicinal knowledge were recorded when informants were grouped according to age, education, and number of children. Issues discussed in this research could hopefully raise awareness on changes in healthcare practices in indigenous cultures and on medical safety especially when traditional and conventional medications interact.

Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan

ETHNOPHARMACOLOGICAL RELEVANCE

Mapping ethnomedicinal plants and associated indigenous knowledge of folk medicines can provide a comprehensive overview of individual herbs employed in health care. Reliance on medicinal plants in remote parts of northern Pakistan is high, especially among women, but no research has investigated specifically which plants are used. This study investigated indigenous knowledge of folk medicines among tribal minorities in selected sites in upper Swat, Buner and Chitral Districts in Khyber Pakhtunkhwa Province.

MATERIALS AND METHODS

Interviews were conducted with gender-specific focus groups using questionnaires and standardized data sheets, followed by forest walks in each of the visited areas. General medicinal herb use, preparations, storage, marketing and collection habits for each gender group were ascertained from the questionnaires.

RESULTS

In total 168 women and 390 men were interviewed and provided information on 127 different shared medicinal species. Species use consensus among the informants ranged from 2.3% to 83.3%, with Cynodon dactylon, Avena sativa, Celtis australis, Datura stramonium, Solanum nigrum, Skimmia laureola, Spiraea nervosa, Ziziphus jujuba, Rumex hastatus, Plantago lanceolata, Lathyrus aphaca and Ficus palmata having the highest reported consensus. The survey also revealed that a number of medicinal species were exploited by the community for both marketing and personal use, and many of these species were reported as being rare, vulnerable or even endangered.

CONCLUSIONS

The results revealed that women in all the three districts were important custodians of medicinal plant knowledge, but elder women in general and the women from Buner district in particular had a superior understanding of folk medicine. The forest walks revealed that women׳s traditional medicinal knowledge was based on a more limited diversity of plant species. People in tribal communities have an expressed interest in learning efficient techniques for medicinal plant collection, preparation, storage and cultivation advice, and to learn more about the potential of marketing medicinal herbs and ways to reach local market centers. Education and awareness were considered to be essential for improved health care and successful marketing.

Medicinal plants used for menstrual disorders in Latin America, the Caribbean, sub-Saharan Africa, South and Southeast Asia and their uterine properties: a review

ETHNOPHARMACOLOGICAL RELEVANCE

Menstrual disorders are generally not perceived as major health concerns by global health organizations, despite being disruptive to women׳s daily activities, particularly when access to sanitary facilities or analgesics is limited. Improving menstrual health requires access to safe and effective medication, but many women in Latin America, Africa or Asia prefer traditional medicine above modern remedies (such as contraceptives), as they can cause physical symptoms associated with fertility loss. Many medicinal plants are used for menstrual disorders, but few have been examined for their pharmacological activities related to traditional uses. Plants that have a smooth muscle-relaxant effect could ease menstrual cramps, but there are indications that dysmenorrhea in low-income countries is commonly treated with emmenagogues. This review aims to assess the most salient plants used to treat menstrual morbidity in Latin America and the Caribbean, sub-Saharan Africa, South and Southeast Asia, their uterine properties and adverse effects. To test whether plants used for painful menstruation could have uterine contracting properties, we recorded whether these species were also used to ease birth, induce menstruation, abortion or expel the afterbirth, as these suggest spasmogenic activities.

MATERIALS AND METHODS

We reviewed the literature documenting traditional plant use in the study area for dysmenorrhea, regulating or inducing menstruation, uterine cleansing, uterine fibroids, expelling the placenta and lochia and for easing childbirth. Thirty genera (59 species) used in at least two continents or frequently throughout one continent, where shortlisted from the 90 most salient plant species emerging from our literature review. Using Medline, we searched for pharmacological properties and/or mechanisms of action relevant to their traditional uses of the shortlisted species. We searched VigiBase™, the WHO global individual case safety report database, on reported adverse drug reactions associated with these species.

RESULTS

More than 2000 plant species are used for menstrual disorders in the study area. The most salient uses are to treat painful menstruation, induce or regulate menses, and induce abortion. Around half (29) of the 59 most salient species have been tested for their pharmacological effects, of which 48% act as uterine spasmolytics and 31% as uterine spasmogenics. Several frequently used species contain toxic constituents, which may put women and their unborn children at serious risk. VigiBase(TM) listed adverse drug reactions for 18 of these species, but few reports came from the study area.

CONCLUSIONS

Research into the risks and benefits of medicinal plants for menstrual complaints should be given a higher priority in reproductive health programs that respect traditional knowledge and practices. Increased data collection is needed on adverse drug reactions among women using herbal medicines for reproductive health, especially in countries with limited reproductive health facilities.

Ethnobotany in Rayones, Nuevo León, México

BACKGROUND

Trough collections of plants and interviews with 110 individuals, an ethnobotanical study was conducted in order to determine the knowledge and use plant species in Rayones, Nuevo Leon, Mexico. The aim of this study was to record all useful plants and their uses, to know whether differences exist in the knowledge about the number of species and uses between women and men, and to know if there is a correlation between the age of individuals and knowledge of species and their uses.

METHODS

A total of 110 persons were interviewed (56 men, 56 women). Semistructured interviews were carried out. The data were analyzed by means of Student t test and the Pearson Correlation Coeficient.

RESULTS

A total of 252 species, 228 genera and 91 families of vascular plants were recorded. Astraceae, Fabaceae and are the most important families with useful species and Agave and Opuntia are the genera with the highest number of useful species. One hundred and thirty six species are considered as medicinal. Agave, Acacia and Citrus are the genera with the highest number of medicinal species. Other uses includes edible, spiritual rituals, construction and ornamentals. There was a non-significant correlation between the person's age and number of species, but a significant very low negative correlation between the person's age and number of uses was found.

CONCLUSIONS

Knowing their medicinal uses is an important issue for the people of Rayones. Boiling and preparing infusions are the main ways of using plants by residents. The leaves, the branches, and the fruits are the most commonly used parts. Almost 18% of the flora is used for wood and construction purposes. Several uses such as cosmetic, shampoo, firming skin tonics and health hair products recorded in Rayones has not been reported for other areas in the state of Nuevo León. In Rayones, women have a greater knowledge about plants and their uses than men, particularly, medicinal plants, but, men have a greater knowledge about wood and construction species.