Medicinal plants used by the Bapedi traditional healers to treat diarrhoea in the Limpopo Province, South Africa

A scoping review on efficacy and safety of medicinal plants used for the treatment of diarrhea in sub-Saharan Africa

BACKGROUND

In sub-Saharan Africa (SSA), significant morbidity and mortality have been linked to diarrhea, which is frequently caused by microorganisms. A rise in antimicrobial-resistant pathogens has reignited the search for alternative therapies. This scoping review aims to map the literature on medicinal plants in relation to their anti-diarrheal potential from SSA.

METHODS

Studies published from 1990 until April 2022 on medicinal plants used for the treatment of diarrhea from each country in SSA were searched on Scopus, Web of Science, Science Direct and PubMed. The selection of articles was based on the availability of data on the in vitro and/or in vivo, ethnobotanical, and cross-sectional studies on the efficacy of medicinal plants against diarrhea. A total of 67 articles (ethnobotanical (n = 40); in vitro (n = 11), in vivo (n = 7), cross-sectional (n = 3), in vitro and in vivo (n = 2) and ethnobotanical and in vitro (n = 2), were considered for the descriptive analysis, which addressed study characteristics, herbal intervention information, phytochemistry, outcome measures, and toxicity findings.

RESULTS

A total of 587 different plant species (from 123 families) used for diarrhea treatment were identified. Most studies were conducted on plants from the Fabaceae family. The plants with the strongest antimicrobial activity were Indigofera daleoides and Punica granatum. Chromatographic methods were used to isolate six pure compounds from ethyl acetate extract of Hydnora johannis, and spectroscopic methods were used to determine their structures. The majority of anti-diarrheal plants were from South Africa (23.9%), Ethiopia (16.4%), and Uganda (9%). This study highlights the value of traditional remedies in treating common human diseases such as diarrhea in SSA.

CONCLUSION

Baseline knowledge gaps were identified in various parts of SSA. It is therefore recommended that future ethnobotanical studies document the knowledge held by other countries in SSA that have so far received less attention. Additionally, we recommend that future studies conduct phytochemical investigations, particularly on the widely used medicinal plants for the treatment of diarrheal illnesses, which can serve as a foundation for future research into the development of contemporary drugs.

Medicinal plants for treatment of diarrhoeal diseases among under-five children: experience from traditional healers in North-eastern Tanzania

BACKGROUND

Right through history, humans have relied heavily on plants for sustenance and the healing of different ailments. One of the long-standing traditions that communities have inherited from earlier generations is the use of herbal medicines for the treatment of paediatric ailments, including diarrhoea. This study showcased medicinal plants used by traditional healers for the treatment of diarrhoeal diseases among under-five children in North-eastern Tanzania.

METHODS AND DESIGN

A qualitative research approach and a narrative research design were employed. The research was carried out in the districts of Korogwe and Handeni in North-eastern Tanzania, with 52 in-depth interviews performed with participants (traditional healers). Purposive sampling method was used to select participants, and a thematic analysis framework was used to analyze the data.

RESULTS

Study results indicate that traditional healers had enormous insights and were well informed about medicinal plants that were perceived to be efficacious in treating diarrhoeal diseases among under-five children. A total of 54 medicinal plants were reported by the participants to be effective in healing diarrhoeal diseases among under-five children. However, out of 54 medicinal plants, 15 were predominantly disclosed by the majority of participants. Those medicinal plants include Psidium guajava, Rhus natalensis, Ozoroa insignis, Tamarindus indica, Ocimum suave, Combretum molle, Zanha africana, Solanum incanum, and Ximenia americana. Other medicinal plants mentioned by most participants include, Ochna holstii, Elaeodendron schlechterianum, Albizia anthelmintica, Commiphora pteleifolia, Salacia stuhlmanniana, and Zenkerella grotei.

CONCLUSION

All traditional healers seemed to have a clear understanding regarding the medicinal plants that were used to treat diarrhoeal diseases among under-five children. The participants acknowledged to treating under-five children with diarrhoeal diseases using herbal medications on multiple occasions. The findings of this study should inspire more in-depth botanical research to determine whether the medicinal plants reported in this study have anti-diarrhoeal properties.

Medicinal Uses of the Fabaceae Family in Zimbabwe: A Review

The current study is aimed at providing a systematic review of the ethnomedicinal, phytochemical and pharmacological properties of Fabaceae species used as sources of traditional medicinies in Zimbabwe. Fabaceae is one of the well-known plant families of ethnopharmacological importance. Of the approximately 665 species of the Fabaceae family occurring in Zimbabwe, about 101 are used for medicinal purposes. Many communities in the country, mainly in peri-urban, rural and marginalized areas with limited access to healthcare facilities, rely on traditional medicines as their primary healthcare. The study reviewed research studies undertaken on Zimbabwe's Fabaceae species during 1959 to 2022. Information was gathered from literature sourced from Google Scholar, Science Direct, Scopus, PubMed, books, dissertations, theses and scientific reports. This study showed that 101 species are traditionally used to manage human and animal diseases in Zimbabwe. The genera with the highest number of medicinal uses are Indigofera, Senna, Albizia, Rhynchosia and Vachellia. Species of these genera are used as traditional medicines against 134 medical conditions, mainly gastrointestinal conditions, female reproductive conditions, respiratory conditions and sexually transmitted infections. Shrubs (39.0%), trees (37.0%) and herbs (18.0%) are the primary sources of traditional medicines, while roots (80.2%), leaves (36.6%), bark (27.7%) and fruits (8.9%) are the most widely used plant parts. Many of Zimbabwe's Fabaceae species used as sources of traditional medicines have been assessed for their phytochemical and pharmacological properties, corroborating their medicinal uses. However, there is a need to unravel the therapeutic potential of the family through further ethnopharmacological research focusing on toxicological studies, in vitro and in vivo models, biochemical assays and pharmacokinetic studies.

Traditionally used polyherbals in a southern African therapeutic context

ETHNOPHARMACOLOGICAL RELEVANCE

In African traditional medicine, there are several plant species that are used in combination with either other plant species or non-plant derived combinations such as sugar and honey, salt and vinegar, milk, fat etc. This review examines the role of these combinations and postulates the scientific and therapeutic validation of such combinations.

AIM OF THE STUDY

This study reviewed the ethnopharmacological literature and documented the use of southern African plant combinations to find a scientific rationale for such combinations, and provide recommendations for future studies.

MATERIALS AND METHODS

Ethnobotanical books and online databases such as Scopus, ScienceDirect, PubMed and Google Scholar were used to find ethnobotanical studies within the southern African context that focus on the combinations of plants with other plants or various additional ingredients. The scientific literature was examined to determine if evidence was available to substantiate such combinations.

RESULTS

One hundred and eighty-seven medicinal plant (plant-to-plant) combinations that are used in the southern African traditional healing system were recorded. These plant combinations were used against infections of the gastrointestinal tract, respiratory tract, and skin as well other non-infectious diseases such as reproductive and psychiatric disorders. Respiratory infections were the most documented infections to be treated using plant combinations. The plant that was documented to be most commonly used in combination with other plants was Artemisia afra Jacq. ex Willd. While plant-plant combinations have drawn a marked interest, comparatively, plant-adjuvant (e.g. milk, sugar, honey, salt, vinegar, fats) combinations have attracted less research interest. Milk was reported as the most used additional ingredient in combination with medicinal plants. The combination of animal urine and dung with medicinal plants has been reported as a treatment for treat prostate infections, the human immunodeficiency virus (HIV). Other ingredients such as clay and flour were also documented, and these are often mixed with medicinal plants to treat fever, stomach ailments, sexually transmitted infections (STI) and skin conditions. Although combination therapy has been frequently reported in ethnobotanical records, over 90% of the combinations reviewed still need to be scientifically validated.

CONCLUSION

Scientific reports on the antimicrobial, anti-oxidant, anti-inflammatory and other pharmacological effects of these combinations may offer an understanding of traditional combination therapy. In addition, investigation into the mechanisms of action of these combinations are also recommended to supplement the findings. Nonetheless, the use of plant combinations is still an untapped research area in southern Africa and there is a need to validate the use of those documented combinations to obtain a better understanding of combined traditional medicinal plant use.

Intestinal secretory mechanisms and diarrhea

One of the primary functions of the intestinal epithelium is to transport fluid and electrolytes to and from the luminal contents. Under normal circumstances, absorptive and secretory processes are tightly regulated such that absorption predominates, thereby enabling conservation of the large volumes of water that pass through the intestine each day. However, in conditions of secretory diarrhea, this balance becomes dysregulated, so that fluid secretion, driven primarily by Cl- secretion, overwhelms absorptive capacity, leading to increased loss of water in the stool. Secretory diarrheas are common and include those induced by pathogenic bacteria and viruses, allergens, and disruptions to bile acid homeostasis, or as a side effect of many drugs. Here, we review the cellular and molecular mechanisms by which Cl- and fluid secretion in the intestine are regulated, how these mechanisms become dysregulated in conditions of secretory diarrhea, currently available and emerging therapeutic approaches, and how new strategies to exploit intestinal secretory mechanisms are successfully being used in the treatment of constipation.

GC-MS Analysis and In Vivo and Ex Vivo Antidiarrheal and Antispasmodic Effects of the Methanolic Extract of Acacia nilotica

This present study evaluated and rationalized the medicinal use of the fruit part of Acacia nilotica methanolic extract. The phytochemicals were detected using gas chromatography−mass spectrometry (GC−MS) while the in vivo antidiarrheal test was done using Swiss albino mice. To determine the details of the mechanism(s) involved in the antispasmodic effect, isolated rat ileum was chosen using different ex vivo assays by maintaining a physiological environment. GC−MS results showed that A. nilotica contained pyrogallol as the major polyphenol present (64.04%) in addition to polysaccharides, polyphenol, amino acid, steroids, fatty acid esters, and triterpenoids. In the antidiarrheal experiment, A. nilotica inhibited diarrheal episodes in mice significantly (p < 0.05) by 40% protection of mice at 200 mg/kg, while 80% protection was observed at 400 mg/kg by the orally administered extract. The highest antidiarrheal effect was observed with loperamide (p < 0.01), used as a control drug. In the ex vivo experiments, A. nilotica inhibited completely in increasing concentrations (0.3 to 10 mg/mL) the carbachol (CCh; 1 µM) and high K+ (80 mM)-evoked spasms in ileum tissues at equal potencies (p > 0.05), similar to papaverine, a dual inhibitor of the phosphodiesterase enzyme (PDE) and Ca++ channels. The dual inhibitory-like effects of A. nilotica on PDE and Ca++ were further validated when A. nilotica extract (1 and 3 mg/mL)-pre-incubated ileum tissues potentiated and shifted isoprenaline relaxation curves towards lower doses (leftward), similar to papaverine, thus confirming the PDE inhibitory-like mechanism whereas its CCB-like effect of the extract was confirmed at 3 and 5 mg/mL by non-specific inhibition of CaCl2-mediated concentration response curves towards the right with suppression of the maximum peaks, similar to verapamil, used as standard CCB. Thus, this study characterized the chemical composition and provides mechanistic support for medicinal use of A. nilotica in diarrheal and hyperactive gut motility disorders.

Ethnobotany, Ethnopharmacology, and Phytochemistry of Medicinal Plants Used for Treating Human Diarrheal Cases in Rwanda: A Review

Diarrhea, often caused by microorganisms, has been associated with high morbidity and mortality in Africa. Increased rates of antimicrobial-resistant pathogens have reignited the quest for alternative therapies. This review aimed at identifying medicinal plants used in the treatment of human diarrheal cases in Rwanda and analyzing their ethnobotany, ethnopharmacology, and phytochemistry. We searched PubMed/Medline, Google Scholar, ScienceDirect, and the Web of Science for published articles on medicinal plants used to treat diarrhea in Rwanda. Additionally, specialized herbarium documents of different institutes were reviewed. Articles were assessed for relevance, quality, and taxonomical accuracy before being included in this review. Overall, 63 species of medicinal plants belonging to 35 families were recorded. Asteraceae was the predominant family with six species, followed by Fabaceae and Lamiaceae, with five species each. The most reported species with anti-diarrheal properties were Vernonia amygdalina Delile, Tetradenia riparia (Hochst.) Codd, Clerodendrum myricoides R. Br. and Chenopodium ugandae (Aellen) Aellen. Leaves (66.7%) and roots (17.5%) were the commonly used plant parts in the preparation of medicine. Phytochemicals from medicinal plants with antidiarrheic activities were sesquiterpene lactones (V. amygdalina); terpene, sterols, saponosides, and flavonoids (C. ugandae); saponins and tannins (T. riparia); and tannins, flavonoids, and alkaloids (C. myricoides). Six studies tested the antimicrobial activities of the plants against bacteria and viruses known to cause diarrhea. Erythrina abyssinica, Euphorbia tirucalli, Dracaena afromontana, and Ficus thonningii are socio-culturally important. Further research on toxicity and posology is needed to ensure the safety of medicinal plants.

Biological and computational studies provide insights into Caesalphinia digyna Rottler stems

Caesalpinia digyna (Rottl.) (Family: Fabaceae) is an essential medicinal plant for it's conventional uses against a kind of human disorders. This research aims to investigate the antidiarrheal, antibacterial and antifungal properties of the methanol extract of the stems extracts of the C. digyna (MECD). The in vivo antidiarrheal activity of the stem extracts were evaluated by using castor oil-induced diarrhea, castor oil-induced enteropooling and charcoal induced intestinal transit in mice model. Besides, in vitro antimicrobial potentiality of MECD was investigated by the disc diffusion method. In silico activity of the isolated compounds were performed by Schrödinger-Maestro (Version 11.1) software. In addition, The ADME/T analysis and PASS prediction were implemented by using pass online tools. In the antidiarrheal investigation, the MECD exhibited a notable inhibition rate in all test approaches which were statistically significant (p < 0.05, p < 0.1, p < 0.01). MECD 400 mg/kg showed the maximum antidiarrheal potency in all the test methods. In vitro antimicrobial analysis unveiled that, MECD revealed higher potentiality against almost all pathogens and indicates dose-dependent activity against almost all the bacteria and fungi. In the case of in silico evaluation of anti-diarrheal, anti-bacterial and anti-fungal activity, all three isolated compounds met the pre-conditions of Lipinski's five rules for drug discovery. Pass predicted study also employed for all compounds. However, The chemical constituents of the C. digyna can be a potent source of anti-diarrheal, anti-bacterial and anti-fungal medicine and further modification and simulation studies are required to establish the effectiveness of bioactive compounds.

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Caesalpinia digyna is used to prepare therapeutic product "Geriforte".

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The pods, bark and seed pods of C. digyna contains high amount of tannins and flavonoids.

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Caesalpinia digyna is used to treat diarrhea, chronic fluxes, senile pruritis, tuberculosis, tonic disorder, and diabetes.

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This study is to validate the ethnopharmacological values of C. digyna stems.

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This is the first research work till now where, the stems of C. digyna have been studied.

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The results of in vivo, in vitro and in silico studies is comparatively closer to the standard drugs.

Medicinal plants used by 'root doctors', local traditional healers in Bié province, Angola

ETHNOPHARMACOLOGICAL RELEVANCE

This study is one of the first post-civil war efforts to document traditional botanical knowledge in Bié province, central Angola, in a first step to bring more studies on the use of medicinal plant resources in this area so as to bring new insights into Angolan bio-cultural diversity.

AIM OF THE STUDY

Examine the variety of plant species used for medical purposes, as well as characterize their social and cultural values. Also, it is aimed to compare their uses in the studied region with those in Sub-Saharan Africa and report new ethnomedicinal uses.

MATERIALS AND METHODS

We documented traditional medicinal plant knowledge among professional herbalists in two areas in Bié province through participatory observation, semi-structured interviews and transect walks. Ethnobotanical information was quantified based on Use Reports to (1) rate traditional knowledge; and (2) determine most useful taxa.

RESULTS

In total, 10 traditional healers shared information on their knowledge. A total of 87 plant species distributed among 57 genera and 36 botanical families were documented with Fabaceae being the best-represented family with 18 species, followed by Phyllanthaceae (6), Apocynaceae (5), Asteraceae (5), Rubiaceae (5), Lamiaceae (4), and Ochnaceae (3). Most medicinal plants are usually gathered at a distance from human settlements because of the belief in the higher efficacy of 'wild' plants shared by all herbalists. Roots are the most common plant part used (79%), explaining why the consulted herbalists call themselves 'root doctors'.

CONCLUSIONS

The culturally most important medicinal species identified in this study, i.e. Securidaca longepedunculata, Garcinia huillensis, Annona stenophylla, Afzelia quanzensis and Strychnos cocculoides, were previously reported for the same use in neighbouring countries and elsewhere in Africa. Our study also indicates that there are several locally valuable species that have not yet been studied for their medical potential, to name a few: Alvesia rosmarinifolia, Diplorhynchus condylocarpon, Eriosema affine, Paropsia brazzaeana, Rhus squalida, Sclerocroton cornutus or Xylopia tomentosa. Moreover, the ethnomedicinal use of 26 species was reported for the first time to sub-Saharan Africa.

CLASSIFICATION

Ethnopharmacological field studies.

In Silico, Ex Vivo and In Vivo Studies of Roflumilast as a Potential Antidiarrheal and Antispasmodic agent: Inhibition of the PDE-4 Enzyme and Voltage-gated Ca++ ion Channels

The aim of the present study was to evaluate the possible gut inhibitory role of the phosphodiesterase (PDE) inhibitor roflumilast. Increasing doses of roflumilast were tested against castor oil-induced diarrhea in mice, whereas the pharmacodynamics of the same effect was determined in isolated rabbit jejunum tissues. For in silico analysis, the identified PDE protein was docked with roflumilast and papaverine using the Autodock vina program from the PyRx virtual screening tool. Roflumilast protected against diarrhea significantly at 0.5 and 1.5 mg/kg doses, with 40% and 80% protection. Ex vivo findings from jejunum tissues show that roflumilast possesses an antispasmodic effect by inhibiting spontaneous contractions in a concentration-dependent manner. Roflumilast reversed carbachol (CCh, 1 µM)-mediated and potassium (K+, 80 mM)-mediated contractile responses with comparable efficacies but different potencies. The observed potency against K+ was significantly higher in comparison to CCh, similar to verapamil. Experiments were extended to further confirm the inhibitory effect on Ca++ channels. Interestingly, roflumilast deflected Ca++ concentration–response curves (CRCs) to the right with suppression of the maximum peak at both tested doses (0.001-0.003 mg/mL), similar to verapamil. The PDE-inhibitory effect was authenticated when pre-incubation of jejunum tissues with roflumilast (0.03-0.1 mg/mL) produced a leftward deflection of isoprenaline-mediated inhibitory CRCs and increased the tissue level of cAMP, similar to papaverine. This idea was further strengthened by molecular docking studies, where roflumilast exhibited a better binding affinity (-9.4 kcal/mol) with the PDE protein than the standard papaverine (-8.3 kcal/mol). In conclusion, inhibition of Ca++ channels and the PDE-4 enzyme explains the pharmacodynamics of the gut inhibitory effect of roflumilast.

The Anti-diarrheal Activity of the Non-toxic Dihuang Powder in Mice

Dihuang powder (DHP) has been used in the traditional Chinese medicine for the treatment of diarrhea in some regions of China. But up to now, the anti-diarrheal activity of DHP haven't been performed with modern pharmacological technology. This study aims to investigate the quality control, the potential toxicity and anti-diarrheal activity of Dihuang powder in mice. High performance liquid chromatography (HPLC) and thin layer chromatography (TLC) were used to detect five active compounds in DHP for quality control, and the acute toxicity and sub-acute toxicity for 28-day oral administration of DHP were then evaluated. The anti-diarrheal activity was investigated using mouse model. Results showed that the levels of quercetin and berberine in DHP were 0.054 and 0.632 mg/g, respectively, and atractylodin, matrine, and patehouli aleohal were also detected in DHP. At the given doses, DHP was safe in terms of acute and sub-acute toxicity. Meanwhile, DHP exhibited strong anti-diarrheal effects as well as decreased gastrointestinal motility and the secretions induced by Sennae and castor oil in a dose-dependent manner. It could decrease the content of IL-1β, IL-6, and TNF-α in the small intestine, and improve the histopathological changes of small intestine and large intestine induced by Sennae. The antinociceptive and anti-inflammatory activities in vivo also were presented. Based on all of the results, we thought that DHP has anti-diarrheal activity, and could be used to treat diarrhea as well as alleviate the pain and inflammation induced by diarrhea. This study provides a theoretical basis for the clinical use of DHP and may assist in the development of new drugs for the treatment of diarrhea. The mechanism of the anti-diarrheal activity should be investigated in the future.

Ethnobotanical knowledge of the lay people of Blouberg area (Pedi tribe), Limpopo Province, South Africa

BACKGROUND

Limpopo province, South Africa, has a rich plant diversity and is referred to as one of the hotspots areas within the country. The aim of the current work was to identify and document medicinal plant species used by the indigenous Pedi people of Blouberg area, Limpopo Province, South Africa.

METHODS

A total of 40 informants which includes both traditional healers and medicinal plant sellers were randomly selected and asked about the plant species used in treatment of variety of infections using a structured questionnaire. Follow-up visits and various field walks were also used to identify and document various plant species used in Traditional medicine (TM). The interviews were carried out from April 2008 to June 2016 using indigenous language (Sehananwa).

RESULTS

A total of 82 medicinal plants species belonging to 42 families have been collected, identified and documented. About 46.34% of the plant species were herbs, followed by trees (25.61%), shrubs (20.73%) and climbers (7.32%). The most used plant parts are roots and rhizomes (58.58%). Peltophorum africanum Sond revealed frequency index of greater than 70 and is used in combination with other plants species to treat various pathogenic infections. Most of the plant species reported are used in the treatment of sexually transmitted infections (24), management of HIV-AIDS (15) and stomach ache (14). Our informants indicated that the use of plant medicines in combinations is also applied to cure pathogenic infections.

CONCLUSION

The current study demonstrate that the indigenous people of Blouberg area, Limpopo Province harbours an important information about the vegetation around them. The plant species are used in the treatment of various pathogenic infections, offers fruits as additional source of food and form integral part of other medicinal products that may in turn produce income.

Bioprospecting of South African Plants as a Unique Resource for Bioactive Endophytic Microbes

South Africa has a long history and strong belief in traditional herbal medicines. Using ethnobotanical knowledge as a lead, a large number of South African medicinal plants have been discovered to possess a wide spectrum of pharmacological properties. In this review, bioprospecting of endophytes is highlighted by following the advantages of the ethnomedicinal approach together with identifying unique medicinal plants where biological activity may be due to endophytes. This review focuses on the current status of South African medicinal plants to motivate the research community to harness the benefits of ethnobotanical knowledge to investigate the presence of endophytic microbes from the most potent South African medicinal plants. The potential chemical diversity and subsequent putative medicinal value of endophytes is deserving of further research. A timely and comprehensive review of literature on recently isolated endophytes and their metabolites was conducted. Worldwide literature from the last 2 years demonstrating the importance of ethnobotanical knowledge as a useful approach to discover endophytic microbes was documented. Information was obtained from scientific databases such as Pubmed, Scopus, Scirus, Google Scholar, Dictionary of Natural Products, Chemical Abstracts Services, official websites, and scientific databases on ethnomedicines. Primary sources such as books, reports, dissertations, and thesises were accessed where available. Recently published information on isolated endophytes with promising bioactivity and their bioactive natural products worldwide (2015-2017) was summarized. The potential value of South African medicinal plants as sources of endophytes is discussed. The insights provided through this study indicate that medicinal plants in South Africa are highly under-investigated sources of potentially useful endophytic microbes. New approaches may be used by medicinal plant scientists for further exploration of natural products from endophytic fungi and bacteria in southern Africa.

Lippia javanica (Burm.f.) Spreng.: Traditional and Commercial Uses and Phytochemical and Pharmacological Significance in the African and Indian Subcontinent

Lippia javanica occurs naturally in central, eastern, and southern Africa and has also been recorded in the tropical Indian subcontinent. The potential of L. javanica as herbal or recreational tea and herbal medicine and its associated phytochemistry and biological properties are reviewed. The extensive literature survey revealed that L. javanica is used as herbal tea and has ethnomedicinal applications such as in colds, cough, fever, malaria, wounds, diarrhoea, chest pains, bronchitis, and asthma. Multiple classes of phytochemicals including volatile and nonvolatile secondary metabolites such as alkaloids, amino acids, flavonoids, iridoids, and triterpenes as well as several minerals have been identified from L. javanica. Scientific studies on L. javanica indicate that it has a wide range of pharmacological activities which include anticancer, antiamoebic, antidiabetic, antimalarial, antimicrobial, antioxidant, antiplasmodial, and pesticidal effects. Although many of the traditional uses of L. javanica have been validated by phytochemical and pharmacological studies, there are still some gaps where current knowledge could be improved. Lippia javanica is popular as both herbal and recreational tea, but there is need for more precise studies to evaluate the safety and clinical value of its main active crude and pure compounds and to clarify their mechanisms of action.

Psidium guajava L., from ethnobiology to scientific evaluation: Elucidating bioactivity against pathogenic microorganisms

ETHNOPHARMACOLOGICAL RELEVANCE

The use of popular plants has guided pharmaceutical research aimed at combating pathogenic microorganisms. Psidium guajava L. is a plant of great versatility and it has been used both as food and as a therapeutic agent. Root, bark, leaves, fruits, flowers and seeds are used for medicinal purposes, especially in infusions and decoctions for oral and topical use. P. guajava is utilized in symptomatology treatment related to organ malfunction and of diseases caused by the action of pathogenic and/or opportunistic microorganisms. Many pharmacological studies have been conducted to scientifically assess its therapeutic potential.

AIMS OF STUDY

The aim of the current study is to relate the popular use of this plant and its bioscientific assessment as a therapeutic agent in the treatment of diseases and symptoms caused by the action of protozoa, fungi, bacteria and viruses, and also evaluate the safety for the usage and the interaction with drugs.

MATERIALS AND METHODS

A bibliographic database the ethnobiology of Psidium guajava (2005-2015) and the pharmacological infections and parasitic diseases (2010-2015). Searches were done in scientific disclosure databases such as PubMed, Web of Science, and Scopus.

RESULTS

P. guajava leaf extracts were scientifically investigated for the treatment of diseases caused by protozoa (leishmaniasis, malaria, giardiasis, amoebiasis and trichomoniasis), fungi (dermatosis, systemic and mucocutaneous diseases), bacteria (respiratory, mucocutaneous and gastrointestinal infections, cholera, gastritis and stomach ulcers, oral and periodontal infections, venereal diseases and urinary infections) and viruses (herpes, influenza, rotavirus disease and AIDS). The toxicity assays indicates the safet for usage.

CONCLUSIONS

Highlight and elucidate the therapeutic potential and versatility of P. guajava. They also justify using ethnobiology efficiency to guide pharmacological studies. Some limitations can be observed in this kind of study, as the lack for ethnobiological informations and the absence of some controls in the assays.

Toxicological implications and laxative potential of ethanol root extract of Morella serrata in loperamide-induced constipated Wistar rats

CONTEXT

Morella serrata L. (Myricaceae) is commonly used in South Africa to treat several diseases including constipation.

OBJECTIVES

This study investigated toxicological implications and laxative potential of the ethanol root extract of the plant.

MATERIALS AND METHODS

While normal control animals were placed on sterile placebo, the loperamide-constipated rats were treated with the extract at 75, 150 and 300 mg/kg doses for 7 days, and their feeding patterns and faecal properties were monitored. Gastrointestinal transit ratio and the toxicity profile of the tested doses were thereafter evaluated.

RESULTS

The significantly increased faecal volume (192.08%), feed (63.63%), water intake (55.97%) and improved intestinal motility (95.05%) in the constipated rats following treatment with the extract (at 300 mg/kg) suggested laxative potential of the extract. The 1.5-2.0-fold normalization of the platelets, erythrocytes and leukocytes counts in the extract-treated constipated rats suggests its non-haematotoxic tendency. Furthermore, the extract (at the highest investigated dose) reversed the attenuation in the concentrations of the electrolytes (0.5-2-fold), total protein (62.12%) and albumin (55.88%) in the constipated animals as well as attenuated activities of hepatic enzymes (0.5-3.0-fold) and levels of urea (126.67%), creatinine (40.32%), cholesterol (3-fold) and triglycerides (9-fold). These further support its non-toxic and therapeutic attributes against constipation.

CONCLUSION

Overall, the effect exhibited by M. serrata in this study competed well with Senokot (standard drug) and proved that it may be relatively safe and with excellent laxative potential, thus, supporting its pharmacological applications in South Africa.

TREATMENT OF DIARRHOEA USING TRADITIONAL MEDICINES: CONTEMPORARY RESEARCH IN SOUTH AFRICA AND ZIMBABWE

BACKGROUND

Gastrointestinal disorders, diarrhoea in particular remain a major concern in South Africa and Zimbabwe resulting in high mortality rates when left untreated. This investigation was aimed at documenting herbal medicines used in the treatment of diarrhoea in South Africa and Zimbabwe.

MATERIALS AND METHODS

A review of literature on plant species used as remedies for diarrhoea in South Africa and Zimbabwe was undertaken by the use of different electronic databases such as Google Scholar, ScienceDirect, Scopus as well as library searches at the University of Fort Hare, South Africa and the National Herbarium of Zimbabwe (SRGH) in Harare, Zimbabwe.

RESULTS

This study reported ten plant species most widely used to treat diarrhoea in South Africa and Zimbabwe. Of the lot, Sclerocarya birrea (A. Rich.) Hochst. was the most popular medicinal plant used as antidiarrhoeal remedy (11 literature citations) in South Africa and Zimbabwe, followed by Elephantorrhiza elephantina (Burch.) Skeels and Schotia brachypetala Sond. with eight literature citations each. The roots (47.4%) are the most frequently used plant parts, followed by bark (26.3%), leaves (21.1%) and rhizomes (5.3%).

CONCLUSION

The documented antidiarrhoeal activities of this repository of selected plant species against diarrhoea causing agents such as rotavirus, Escherichia coli, Shigella, Campylobacter, Giardia, Entamoeba histolytica, Salmonella, Yersinia and Vibrio cholerae calls for further investigation aimed at isolating phytochemical compounds responsible for antidiarrhoeal activities, their mode of action, and also establish their safety and efficacy. This cross-cultural acceptance of antidiarrhoeal herbal medicines and the use of the same plant species in different geographical zones serve as an indication of the importance of herbal medicines in primary healthcare of local communities.

Ethnopharmacological survey about medicinal plants utilized by herbalists and traditional practitioner healers for treatments of diarrhea in the West Bank/Palestine

ETHNOPHARMACOLOGICAL RELEVANCE

Folk herbal medicine knowledge and its utilization by aboriginal cultures are not only useful for conservation of cultural traditions and biodiversity, but also useful for community healthcare and drug discovery in the present and in the future.

AIM OF THE STUDY

Using a semi-structured questionnaire, an ethnopharmacological survey of medicinal plants used for treatment of diarrhea in the West Bank/Palestine was investigated.

RESULTS

Information about fifty medicinal plants used for treatment of diarrhea, including the names of plants, parts used, mode and methods of preparation was obtained from 100 traditional healers and herbalists. This research is the first scientific work in the Middle East to collect data about plants used by traditional healers for treatments of diarrhea and their evidence based effects against this disease. The fidelity levels were 97% for Salvia fruticosa, Teucrium polium and Musa paradisiaca, 95% for Camellia sinensis and Aegle marmelos, 79% for Oryza sativa and Solanum tuberosum, 77% for Quercus boissieri, 66% for Psidium guajava, 56% for Anthemis palestina, 54% for Solanum nigrum and 52% for Juglans regia while the highest use and choice values were for S. fruticosa, T. polium and M. paradisiaca as well as the factor of informant's consensus for medicinal plants used for treatment of diarrhea was 0.505.The leaves were the most commonly used parts, followed by fruits, roots and rhizomes, while decoctions and infusions are the preferred methods of preparation.

CONCLUSIONS

The Palestinian traditional medicine is rich with herbal remedies for treatment of diarrhea in comparison with other countries, but most of these herbal remedies lack standard in-vitro and in-vivo evaluations to establish their antidiarrheal effects. Therefore, the information obtained can serve as a basis for further phytochemical and pharmacological studies to determine their efficacy and safety which might contribute to a better integration of Palestinian traditional medicine into the national health system in the future.

Cytotoxicity of 91 Kenyan indigenous medicinal plants towards human CCRF-CEM leukemia cells

ETHNOPHARMACOLOGICAL RELEVANCE

Plants from Kenyan flora are traditionally used against many ailments, including cancer and related diseases. Cancer is characterized as a condition with complex signs and symptoms. Recently there are recommendations that ethnopharmacological usages such as immune and skin disorders, inflammatory, infectious, parasitic and viral diseases should be taken into account when selecting plants that treat cancer.

AIM

The present study was aimed at investigating the cytotoxicity of a plethora of 145 plant parts from 91 medicinal plants, most of which are used in the management of cancer and related diseases by different communities in Kenya, against CCRF-CEM leukemia cell line.

MATERIALS AND METHODS

Extracts from different plant parts (leaves, stems, stem bark, roots, root barks, aerial parts and whole herb) were obtained by cold percolation using different solvent systems, such as (1:1v/v) dichloromethane (CH2Cl2) and n-hexane (1), methanol (MeOH) and CH2Cl2 (2); neat MeOH (3), 5% H2O in MeOH (4) and with ethanol (EtOH, 5); their cytotoxicities were determined using the resazurin reduction assay against CCRF-CEM cells.

RESULTS

At a single concentration of 10μg/mL, 12 out of 145 extracts exhibited more than 50% cell inhibition. These include samples from the root bark of Erythrina sacleuxii (extracted with 50% n-hexane-CH2Cl2), the leaves of Albizia gummifera, and Strychnos usambarensis, the stem bark of Zanthoxylum gilletii, Bridelia micrantha, Croton sylvaticus, and Albizia schimperiana; the root bark of Erythrina burttii and E. sacleuxii (extracted with 50% CH2Cl2-MeOH), the stem bark of B. micrantha and Z. gilletii (extracted using 5% MeOH-H2O) and from the berries of Solanum aculeastrum (extracted with neat EtOH). The EtOH extract of the berries of S. aculeastrum and A. schimperiana stem bark extract displayed the highest cytotoxicity towards leukemia CCRF-CEM cells, with IC50 values of 1.36 and 2.97µg/mL, respectively. Other extracts having good activities included the extracts of the stem barks of Z. gilletii and B. micrantha and leaves of S. usambarensis with IC50 values of 9.04, 9.43 and 11.09µg/mL, respectively.

CONCLUSIONS

The results of this study provided information related to the possible use of some Kenyam medicinal plants, and mostly S. aculeastrum, A. schimperiana, C. sylvaticus, Z. gilletii, B. micrantha and S. usambarensis in the treatment of leukemia. The reported data helped to authenticate the claimed traditional use of these plants. However, most plants are used in combination as traditional herbal concoctions. Hence, the cytotoxicity of corresponding plant combinations should be tested in vitro to authenticate the traditional medical practitioners actual practices.

Phytochemical characterization and bioactive properties of Osyris quadripartita Salzm. ex Decne. leaves from Algeria

Medicinal plants are sources of bioactive compounds with recognized beneficial effects on human health.

Traditional uses of medicinal plants in gastrointestinal disorders in Nepal

ETHNOPHARMACOLOGICAL RELEVANCE

Gastrointestinal disorders cause morbidity and can lead to mortality, especially in the developing world where sanitation is deficient. A large part of the human population relies on medicinal plants for treating various diseases, including gastrointestinal disorders. The present review summarizes the traditional uses of medicinal plants of Nepal used to treat gastrointestinal disorders, and evaluates their bio-efficacy based on a review of the available phytochemical and pharmacological literature.

MATERIAL AND METHODS

We searched different electronic databases and libraries for the literature on medicinal plants used in Nepal to treat gastrointestinal disorders. For each species, we also searched the literature for information on conservation status, as well as for phytochemical and pharmacological studies in support of the ethnobotanical information. We used principal component analysis to explore the relation among disorders and plant families, plant life forms, plant parts and preparation modes. We also performed permutation tests to determine if botanical families were used more often than expected considering their availability in the Nepali flora.

RESULTS

We documented a total of 947 species belonging to 158 families and 586 genera used to treat gastrointestinal disorders in Nepal. Diarrhea was the disorder treated by the highest number of species (348), followed by stomachache (340) and dysentery (307). Among the reported species, five were endemic to Nepal, whereas 16 orchid species were protected under CITES Appendices II and III. The randomization test showed that species belonging to 14 families were used less often than expected, whereas plants belonging to 25 families were used more often than expected. The PCA scatter plot showed distinct groups of gastrointestinal disorders treated with similar plant life forms, plant parts, and/or preparation modes. We found 763 phytochemical studies on 324 species and 654 pharmacological studies on 269 species.

CONCLUSION

We showed the diversity and importance of medicinal plants used to treat gastrointestinal disorders in the traditional health care system of Nepal. As such disorders are still causing several deaths each year, it is of the utmost importance to conduct phytochemical and pharmacological studies on the most promising species. It is also crucial to increase access to traditional medicine, especially in rural areas. Threatened species need special attention for traditional herbal medicine to be exploited sustainably.

Anti-diarrhoeal activity of methanol extract of Santalum album L. in mice and gastrointestinal effect on the contraction of isolated jejunum in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Santalum album L., namely Sandalwood, honored as "Green Gold", is a traditional Chinese herb which has the effects of anti-diarrhoeal and antibacterial activity. But there is limit scientific study on its activity and mechanism in gastrointestinal disorders.

MATERIALS AND METHODS

in vivo, after intragastric administration, the methanol extract of Sandalwood (SE) (200, 400 and 800 mg/kg) were studied in castor oil-induced diarrhoea mice. By the test of small intestinal hyperfunction induced by neostigmine, SE was studied on gastrointestinal transit including gastric emptying and small intestinal motility. Meanwhile, in vitro, the effects of SE (0.02, 0.05, 0.1, 0.2, 0.3, 0.4 mg/mL) on the isolated tissue preparations of rat jejunum were also investigated. The rat jejunum strips were pre-contracted with acetylcholine (Ach; 10(-6)M), 5-hydroxytryptamine (5-HT, 200 μM) or potassium chloride (KCl; 60 mM) and tested in the presence of SE. In addition, the possible myogenic effect was analyzed in the pretreatment of the jejunum preparations with SE or verapamil in Ca(2+)-free high-K(+) (60 mM) solution containing EDTA.

RESULTS

At doses of 200, 400 and 800 mg/kg, SE showed significant anti-diarrhoeal activity against castor oil-induced diarrhoea as compared with the control. At the same doses, it also inhibited the gastric emptying and small intestinal motility in the mice of which small intestinal hyperfunction induced by neostigmine. It caused inhibitory effects on the spontaneous contraction of rat-isolated jejunum in dose-dependent manner ranging from 0.02 to 0.4 mg/mL, and it also relaxed the Ach-induced, 5-HT-induced and K(+)-induced contractions. SE shifted the Ca(2+) concentration-response curves to right, similar to that caused by verapamil (0.025 mM).

CONCLUSIONS

These findings indicated that SE played a spasmolytic role in gastrointestinal motility which was probably mediated through inhibition of muscarinic receptors, 5-HT receptors and calcium influx. All these results provide pharmacological basis for its clinical use in gastrointestinal tract.

The genus Warburgia: a review of its traditional uses and pharmacology

CONTEXT

Warburgia (Canellaceae) species have a long history of ethnomedicinal uses in east, central and southern Africa. Due to the popularity of Warburgia as a source of ethnomedicines; all the species are severely over-harvested throughout their distributional ranges.

OBJECTIVE

This review documents fragmented information on traditional uses and pharmacological evidence of the genus Warburgia.

METHODS

Information on Warburgia species was collected from scientific journals, books, theses and reports via library and electronic search using Medline, Pubmed, Google Scholar, ScienceDirect and Web of Science.

RESULTS

Ethnomedicinal uses of Warburgia species have been recorded from east, central and southern Africa for 30 human and 7 animal ailments. Warburgia species are used to treat gastro-intestinal disorders, cold, cough and sore throat; fever or malaria, respiratory and odontological ailments. Warburgia species are rich in drimane and colorotane sesquiterpenoides, and other compounds. The extracts of Warburgia, particularly those from stem bark and leaves, exhibited a wide range of pharmacological effects, including antibacterial, antifungal, antimycobacterial, antioxidant, anti-inflammatory, antifeedant, antiplasmodial, antileishmanial, anthelmintic, cytotoxic and molluscicidal activities.

CONCLUSION

Pharmacological results have validated the use of this genus in traditional medicine. Further investigations are needed to explore the bioactive compounds responsible for the in vitro and in vivo pharmacological effects and their mode of action.

Mixed Methods in CAM Research: A Systematic Review of Studies Published in 2012

Background. Mixed methods research uses qualitative and quantitative methods together in a single study or a series of related studies. Objectives. To review the prevalence and quality of mixed methods studies in complementary medicine. Methods. All studies published in the top 10 integrative and complementary medicine journals in 2012 were screened. The quality of mixed methods studies was appraised using a published tool designed for mixed methods studies. Results. 4% of papers (95 out of 2349) reported mixed methods studies, 80 of which met criteria for applying the quality appraisal tool. The most popular formal mixed methods design was triangulation (used by 74% of studies), followed by embedded (14%), sequential explanatory (8%), and finally sequential exploratory (5%). Quantitative components were generally of higher quality than qualitative components; when quantitative components involved RCTs they were of particularly high quality. Common methodological limitations were identified. Most strikingly, none of the 80 mixed methods studies addressed the philosophical tensions inherent in mixing qualitative and quantitative methods. Conclusions and Implications. The quality of mixed methods research in CAM can be enhanced by addressing philosophical tensions and improving reporting of (a) analytic methods and reflexivity (in qualitative components) and (b) sampling and recruitment-related procedures (in all components).

Isolation and characterization of antimicrobial constituents of Searsia chirindensis L. (Anacardiaceae) leaf extracts

ETHNOPHARMACOLOGICAL RELEVANCE

Searsia chirindensis is used in South African traditional medicine for management of bacterial infections such as diarrhoea. Aim of the study was to examine the phytochemical composition from the leaves of Searsia chirindensis that is responsible for the ethnomedicinal use of this plant.

MATERIALS AND METHODS

The crude extract (80% methanol) was extracted sequentially with dichloromethane (DCM), ethyl acetate (EtOAc) and n-butanol. The extracts and isolated compounds were tested for their antibacterial activity against Gram-negative (Campylobacter jejuni, Escherichia coli and Shigella flexneri) and Gram-positive (Staphylococcus aureus) bacterial strains using the microdilution method. Bioguided fractionation of EtOAc fraction afforded five phenolic compounds. Structural elucidation was carried out using NMR (1D and 2D) spectroscopic analyses.

RESULTS

Of the three fractions obtained from the crude extract, EtOAc was the most active and its fractionation afforded methyl gallate (1), and four flavonol glycosides: myricetin-3-O-arabinopyranoside (2), myricetrin-3-O-rhamnoside (3), kaempferol-3-O-rhamnoside (4) and quercetin-3-O-arabinofuranoside (5). These compounds are reported from Searsia chirindensis for the first time. All the compounds showed good antibacterial activity against all bacterial strains tested. Their minimum inhibitory concentrations ranged from 30 to 250 µg/mL.

CONCLUSIONS

Antibacterial activity demonstrated by the extracts and isolated compounds provides credence to the ethnomedicinal use of Searsia chirindensis against diarrhoea.

Underestimating the toxicological challenges associated with the use of herbal medicinal products in developing countries

Various reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. The World Health Organisation indicates that 80% of the Asian and African populations rely on traditional medicine as the primary method for their health care needs. Since time immemorial and despite the beneficial and traditional roles of herbs in different communities, the toxicity and herb-drug interactions that emanate from this practice have led to severe adverse effects and fatalities. As a result of the perception that herbal medicinal products have low risk, consumers usually disregard any association between their use and any adverse reactions hence leading to underreporting of adverse reactions. This is particularly common in developing countries and has led to a paucity of scientific data regarding the toxicity and interactions of locally used traditional herbal medicine. Other factors like general lack of compositional and toxicological information of herbs and poor quality of adverse reaction case reports present hurdles which are highly underestimated by the population in the developing world. This review paper addresses these toxicological challenges and calls for natural health product regulations as well as for protocols and guidance documents on safety and toxicity testing of herbal medicinal products.

A bioactivity-guided study on the anti-diarrheal activity of Polygonum chinense Linn

ETHNOPHARMACOLOGICAL RELEVANCE

Polygonum chinense Linn., a folk medicine, has long been used for the treatment of diarrhea and enteritis in southwestern China. However, the components responsible for its anti-diarrheal activity are still poorly understood.

AIM OF THE STUDY

To determine anti-diarrheal activities of Polygonum chinense L. and to identify its active components through bioactivity-guided isolation technique.

MATERIALS AND METHODS

Animals were orally administered with the extract of Polygonum chinense L. The anti-diarrheal effects of 75% ethanol extract, four fractions with different polarities from 75% ethanol extract, different eluates collected from Diaion HP-20 macroporous resin chromatography, ellagic acid and corilagin, were examined based on mouse models of castor oil- and magnesium sulfate-induced diarrhea.

RESULTS

The results showed that the 75% ethanol extract of Polygonum chinense L. exhibited significant anti-diarrheal activities in a dose-dependent manner in two mouse models. Through in vivo bioactivity-guided fractionation processes, n-butanol and aqueous fractions were found to exhibit prominent anti-diarrheal activities, and two major compounds, ellagic acid and corilagin, from these active fractions were found to possess anti-diarrheal effects.

CONCLUSION

Present study provides evidence of the utilization of Polygonum chinense L. for diarrhea, and ellagic acid and corilagin are two components contributing to the anti-diarrheal effect.

The utilization and management of plant resources in rural areas of the Limpopo Province, South Africa

BACKGROUND

Most rural people in the Limpopo Province depend on plant resources to meet their livelihood needs. However, there is insufficient recorded information regarding their use and management. The current study therefore was carried out in selected villages of the Limpopo Province, to close this knowledge gap.

METHODS

Information was collected from 60 people residing in two villages, using a semi-structured questionnaire, supplemented with field observations.

RESULTS

A total of 47 wild plant species (95% indigenous and 5% exotics) from 27 families, mostly from the Fabaceae (17%), Anacardiaceae (9%), and Combretaceae (9%) were documented. These species were used primarily for firewood (40%), food (36%) and medicine (29%). Significantly used species included Sclerocarya birrea (85%), Combretum kraussii (35%) and Harpephyllum caffrum (35%). Local traditional rules and regulations including taboos, social beliefs and fines are in place to aid in the management of communal resources. However, a significant number (67%) of participants mentioned that they were not pleased with these rules and regulations.

CONCLUSION

The current study concluded that plant resources still play an important role in the surveyed rural areas of the Limpopo Province. Furthermore, for sustainable utilization and long-term conservation of plants in these areas the government should assist communities in the management of their plant resources.