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Research ArticleEthnomedicinal Evaluation of Medicinal Plants Used againstGastrointestinal Complaints
Akash Tariq1 Sakina Mussarat1 Muhammad Adnan1 E F Abd_Allah2 Abeer Hashem34
Abdulaziz Abdullah Alqarawi2 and Riaz Ullah5
1Department of Botany Kohat University of Science and Technology Kohat 26000 Pakistan2Plant Production Department College of Food and Agricultural Sciences King Saud University Riyadh 11451 Saudi Arabia3Botany and Microbiology Department College of Science King Saud University Riyadh 11451 Saudi Arabia4Mycology and Plant Disease Survey Department Plant Pathology Research Institute Agriculture Research Center Giza 2109 Egypt5Department of Chemistry Government College Ara Khel Frontier Region Kohat 26000 Pakistan
Correspondence should be addressed to Akash Tariq akashmalik786yahoocom
Received 31 December 2014 Revised 14 March 2015 Accepted 27 April 2015
Academic Editor Gail B Mahady
Copyright copy 2015 Akash Tariq et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited
Aim of the present study was to document ethnomedicinal plants used against gastrointestinal complaints in five selected remoteregions of Pakistan and to select potential medicinal plants for further in vitro and in vivo investigation Data on ethnomedicinalplants and ethnographic profile of respondents was documented using semistructured questionnaires The present study revealedutilization of 52 medicinal plants for the treatment of different gastrointestinal infections in studied regions Apiaceae was the mostdominant family reported to be used for the treatment of these infections (4 plants) Among all the plant parts fruit (24) wholeplants and leaves (23 each) were the most preferred plant parts used by the healers Dosage of recipe was found to be related withthe age of the patient Highest degree of informant consensus was reported for vomiting nausea (092 each) abdominal pain (09)and diarrhea (089)Withania coagulans scored highest FL value (86) followed byMentha longifolia andMelia azadirachta rankedsecond with FL value (75 each) Young generation was found to possess little traditional knowledge about utilizing plant recipesagainst these infections Plants with high Fic and FL values should be subjected for further phytochemical and pharmacologicalinvestigation for scientific validation
1 Introduction
Plants are an important resource of conventional medicinesused against different ailments Rural people who have cen-turyrsquos old traditional knowledge transferred from generationto generation still rely on plant resources for variety ofpurposes such as food fodder and medicines Rural areapeople heavily depend on natural resources due to lack ofmodern medical facilities [1] More than 80 of populationin Pakistan is dependent on traditional medicines for healthpractices [2] but now it is restricted to rural areas [3] due todivergence of people towardmodern health facilities in urbanareas and also due to changing life styles with the passageof time This centuries old traditional knowledge is facingsevere threat due to modernization in rural societies Total6000 plant species have been documented in Pakistan among
which only 600 plants have been reported in ethnomedicinalstudies [4] It is therefore imperative to increase ethnomedic-inal studies in order to preserve this precious knowledgebefore its extinction [5]
Gastrointestinal disorders are common in Southwestof Khyber Pakhtunkhwa because these areas lack hygieniccondition and malnutrition as well as having insufficientavailability of pure water Approximately 103 million peoplein Pakistan with an annual growth rate of 3 [6] andpopulation density is recorded 1518 per square kilometer[7] Major health risks in Pakistan are extensive commu-nicable diseases insufficient sewage systems and lack ofpure drinking water [8 9] The high infant morbidity andmortality rates reflect inadequate nutrition and exposure topolluted water [6] Most of the infectious diseases are causedby microorganism such as Vibrio cholerae Escherichia coli
Hindawi Publishing CorporationBioMed Research InternationalVolume 2015 Article ID 892947 14 pageshttpdxdoiorg1011552015892947
2 BioMed Research International
Shigella spp Salmonella spp Aeromonas spp Pseudomonasspp Campylobacter spp Klebsiella spp and Staphylococcusaureus [10] However antibiotic resistance is a major clinicalproblem in treating infections caused by these microor-ganisms Synthetic drugs such as proton pump inhibitorsH2 receptors cytoprotectants demulcents anticholinergicsantacids and prostaglandin analogues are used for the treat-ment of gastro problems but these drugs produce several sideeffects Herbal remedies are considered as better alternativesfor the treatment For example proton pump inhibitors(omeprazole lansoprazole) may cause nausea abdominalpain constipation and diarrhea and H2 receptor antagonists(cimetidine)may cause gynaecomastia and loss of libido Dueto the occurrence of many side effects by use of syntheticdrugs for many diseases medicinal plants are considered asthe main source of new drugs as they have less or no sideeffects Herbal medicines are considered as safe with lesseradverse effects economical effective relatively less toxic andextensive research is carried out in search for potent drugs ofplant origin [11] In Pakistan and other countries a variety ofmedicinal plants are used against gastrointestinal complaintssuch as diarrhea dysentery and cholera However manyof them have not been screened for their phytochemistryand pharmacological action against microbes which couldsupport their use in traditional medicines
The present study was the first effort to target gastroin-testinal infections and their traditional recipes in five remotesouthern regions of Khyber Pakhtunkhwa province of Pak-istan where these infections were found more common Themain purpose of the study was to conserve the ethnomedic-inal knowledge and to select candidate medicinal plants forfurther phytochemical and pharmacological investigationThe available literature shows that such studies can constitutethe starting point for the development of new drugs [12 13]Our efforts are towards not only providing nutrition andhealth care to the people but also recovering record anddiffuse local botanical knowledge and traditional wisdom
2 Material and Methods21 Study Area The present study was conducted in fivemajor remote areas (Dera Ismail Khan Bannu LakkiMarwatand Karak and Kohat) of Khyber Pakhtunkhwa province ofPakistan (Figure 1) D I Khan is an area of 7326 squarekilometers and is situated between 31∘151015840 and 32∘321015840N latitudeand between 70∘111015840 and 71∘201015840E longitude Most of the areaof D I Khan is flat dry alluvial plains supporting mostlyxerophytic vegetation Dominant plant species are Acaciamodesta Acacia nilotica Calotropis procera Morus albaand Eucalyptus camaldulensis Most of the population ofthe area is rural with low literacy rate and they also lackmodern health facilities hence they are more dependentupon natural resources especially plants for their healthcareand to compensate their low income as well [14] Bannuconsists of a total area of 877 square kilometers with apopulation of 19593 It lies within the Karakoram mountainrange between 32∘43 to 33∘06N latitude and 73∘20 to 70∘07Elongitude The total cultivated area is about 33000 acreswith wheat maize and sugarcane being the main cultivated
crops About 25 of the inhabitants of the area as well asAfghan refugees are engaged in the collection and marketingof medicinal plantsThe area consists of alluvial plain with anannual rainfall of 11136mm The dominant plant species areAcaciamodestaAcacia niloticaCalotropis proceraDodonaeaviscosa andWithania somnifera [15] Karak region is situatedin the south of KPK with total area of 600 square kilometersand lies between 70-40∘ to 71-30∘N latitude and 32-48∘ to 33-23∘E longitude The study area is divided into mountainousarea small hills and plains having most of clayey or sandysoil Wheat corn and gram are the common cultivatedcrops Various plant species dominated the study area suchas Acacia modesta Acacia nilotica Adhatoda vasica Aervajavanica Dodonaea viscosa Eucalyptus lanceolatus Fagoniacretica Rhazya stricta Saccharum arundinaceum Withaniacoagulans and Withania somnifera [16] Kohat is located at33∘35101584013N 71∘26101584029E with an altitude of 489m above sealevel The dominant vegetation of the study area is Zizyphusspecies Acacia species and other xerophytes plants The areais rural in nature and inhabitants are very much dependenton plants for agricultural economic and food purposesLocals of the region use a variety of medicinal plants for thetreatment of various ailments due to expensivemodern drugs[17] Lakki Marwat is situated between 32∘161N latitude and70∘191E longitude at altitude of 200ndash1000m above sea levelThis district covers an area of 3164 km2 with a cultivated areaof approximately 116900 ha The indigenous people of thedistrict are Marwat tribes but a small proportion of othertribes also settled here Transport and minerals are the mainsources of economy in the urban area and agriculture is theprimary livelihood of the rural population The major ethnicgroup in this district speaks Pashto (993) which is spokenin a specific dialect [18] The remaining population speaksPunjabi (07) in Hindko dialect
22 Sampling and Data Collection Data collection was car-ried out from 2013 to 2014 Prior to data collection localadministrative officers of the regions were visited and it wasexplained them themain idea of the study in order to get theirpermission According to the information provided by thelocal administrative officers 350 respondents were selectedin five studied region with 70 informants in each regionThe selection criterion of informants was mainly based ontheir rich indigenous knowledge and long term experienceof utilization of plants as well as their living period of timein the study area Selected respondents of the regions wereaged between 30 and 79 years Verbal consent includingconsent for publication was received from all the informantsbefore the interviews began The informants are aware thatthe information they have provided will be published andthat data will be used only for scientific purposes Data wascollected in local language (Saraiki Hindko and Pashto) andconverted into English Semistructured questionnaires weredesigned to collect ethnomedicinal knowledge of medicinalplants used against gastrointestinal infections
23 Plants Collection and Identification Plants were collectedwith the help of respondents from wild and cultivated areasCollected voucher specimens were taken to the Herbarium
BioMed Research International 3
Afghanistan
Charikar
Jalalabad
Khyber Agency
Kabul
Gardeyz
Khowst
SharZarghun North
SouthWaziristan
Balochistan
WaziristanRazmak
Miranshah
Wana
Jandola
LakkiMarwat
Tank
Zhob
Dera IsmailKhan
Dera
KhanIsmail
Bannu
Karak
Hangu
KurramAgency
ParachinarLandi
MohmandAgency
Kotal
Orakzai Agency
KohatKohat
Mianwali
Kalabagh
Panjab
Pakistan
Islamabad
Murree
India
BajaurAgency
DirDir
Swat
Shangla
Mansehra
Chitral
Chitral
Mastuj
Mt Tirich MirMor Khun
Northern Areas
Gilgit
AgencyMalakand
Nowshera
Charsadda
Peshawar
MardanSwabi
Buner
HaripurAbbottabad
Tajikistan
Kalam DasuKohistan
SaiduSharif
Naran
MansehraBattagram
Figure 1
of Kohat University of Science and Technology (KUST)Kohat Pakistan Specimen identification and confirmationwere undertaken by using Flora of Pakistan and taxonomicexperts Specimens with their label were stored at theHerbar-ium of KUST Kohat Pakistan
24 Data Organization The collected data on ethno medic-inal plants and ethnography of the respondents was orga-nized using Microsoft Excel 2007 and summarized usinggraphical statistical methods such as percentages The habitof the plants was categorized into 3 classes (herbs shrubsand trees) Life form of medicinal plants was classified
into annual biennial and perennial Plant parts use wascategorized into leaves roots stem whole plant seedsfruit and flower Stomach disorders were divided into sixmajor categories that is diarrhea dysentery abdominal painintestinal worms constipation and nausea and vomiting
25 Data Quality Assurance Each respondent was ap-proached at least three times during data collection for 5 thelegitimacy of information they provided Information wasconsidered irrelevant and rejected in case of any divergencefrom the original information of the respondent Valid datawas only subjected to further analysis process Further data
4 BioMed Research International
quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis
26 Data Analysis
261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows
Fic = nur minus ntnur minus 1
(1)
where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used
262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula
FL = IpIutimes 100 (2)
where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]
3 Results
In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred
plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)
Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)
Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives
4 Discussion
41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]
42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs
BioMed Research International 5Ta
ble1Medicinaluses
ofplantsforstomachtro
ubles
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Abutilonindicum
(L)Sw
eet
Malvaceae
Koso
beta
SA
WWhpl
Decoctio
nor
powderisu
sed
againstcon
stipatio
n1tea
spoo
naft
ermeal
2ndash4teas
poon
saft
ermeal
Lakk
iMarwat
Acaciamodesta
Wall
Mim
osaceae
Phulahi
TP
WBa
Decoctio
nismadeb
ybo
iling
bark
inwater
orpo
wdero
fbark
ismadeb
ygrinding
theb
arkfor
treatmento
fgas
troub
leand
abdo
minaldiseases
2spoo
nsaft
er4h
rsfor1
day
3-4spoo
nsaft
er2h
rsfor2
days
ordepend
son
severity
DIK
han
Acacianilotica(L)Delile
Mim
osaceae
Kikar
TP
WPo
Ba
Decoctio
nof
theb
arkisused
indiarrhea
andpo
dsareg
rindedto
makep
owderm
ixed
with
sugar
orho
neyto
treatdysentery
Smallamou
ntof
powderisg
iven
for1-2
days
500m
ggiven
twicea
dayfor3
days
Kohat
Achyranthesa
speraL
Amaranthaceae
Gho
shkai
HP
WWhpl
Itsdecoctionisused
insto
mach
disorderTh
ejuice
ofthep
lant
isused
inabdo
minalpain
dysenteryandin
bowel
complaints
Depends
ondiseases
everity
Depends
ondiseases
everity
Bann
u
Albizialebbeck
(L)Be
nth
Mim
osaceae
Sirin
TP
CBa
Bark
decoctionisused
totre
atdiarrhea
1-2spoo
n3tim
esad
ay1-2
spoo
naft
er3h
rsfor1
day
Bann
u
Alliu
mcepa
LLiliaceae
Piaz
HA
CBu
Equalamou
ntso
fextractof
onionbu
lbandmintare
mixed
andgivenforc
holera
Halftea
spoo
nof
thismixture
istakenperh
our
fora
perio
das
needed
One
teas
poon
ofthismixture
istakenperh
our
fora
perio
das
needed
DIK
han
Argyrolobium
roseum
(Cam
bess)
Jaub
ampSpach
Nyctaginaceae
Muk
hanBu
tti
SB
WWhpl
Diarrhea
Bann
u
Artemisiaa
bsinthium
LAs
teraceae
Afsanteen
HB
WL
Leaves
areb
oiledto
expel
intestinalwormsindigestion
diarrheaand
vomiting
Asn
eeded
Asn
eeded
Kohat
Asparagusadscend
ensR
oxb
Asparagaceae
Safid
muesli
HA
WR
Groun
droot
iseffectiv
efor
carm
inative
Asn
eeded
Asn
eeded
Karak
Azadira
chta
indica
AJuss
Meliaceae
Neem
TP
CL
Decoctio
nof
leaves
istakenfor
digestivea
ndgastric
prob
lems
2teas
poon
sfor
oned
ay2teas
poon
sfor
oned
ay
DIK
han
Lakk
iMarwat
Bisto
rtaam
plexica
ulis(D
Don
)Greene
Polygonaceae
Masloon
Anjabar
HP
WWhpl
Con
stipatio
nBa
nnu
Kohat
Boerhaavia
diffu
saBrandegee
Nyctaginaceae
Punara
HP
WR
Gas
troub
les
Karak
Camelliasin
ensis
(green
tea)
LKu
ntze
Theaceae
Sabz
pati
HP
CL
Leaves
areb
oiledin
water
mixed
somes
ugar
andtake
orallyfor
indigestionandnausea
1orh
alfcup
once
aday
1cup
aday
DIK
han
Bann
uLakk
iMarwat
6 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Carissa
opacaStapfex
Haines
Apocyn
aceae
Grand
aS
AWC
LR
FDysentery
Karak
Carumcopticu
m(L)Be
nthamp
Hoo
kfex
CB
Clarke
Umbelliferae
Spaerkae
HA
CS
Usedin
sore
throatdiarrhea
dysenteryandvomiting
Kohat
Cassiafi
stula
LCa
esalpiniaceae
Amaltas
TP
CF
Apieceo
fthe
fruitcon
taining
10ndash12seedsa
reslightly
grou
ndandbo
iledin
12liter
ofwater
andstr
ainedford
ysentery
1-2teas
poon
s3tim
esdaily
for1-2
days
3-4teas
poon
s3-4tim
esdaily
DIK
han
Bann
u
Cedrus
deodara(Roxbex
D
Don
)GD
onPinaceae
Diar
TA
CWhpl
Gas
troub
les
Karak
Cinn
amom
umzeylanicu
mBlum
eLauraceae
Dalchini
TP
CBa
Bark
powdera
nddecoctionis
used
ingastrointestinaldisorder
vomiting
dysenteryand
diarrhea
Asn
eeded
Asn
eeded
Kohat
Citru
lluscolocynthis(L)Schrad
Cucurbita
ceae
Kartum
ma
HA
WF
Fruitisc
utboiledin
water
and
sugara
dded
tomakem
urabba
used
forc
onstipatio
nand
abdo
minaldiseases
Asn
eeded
Asn
eeded
DIK
han
Bann
uKo
hat
Lakk
iMarwat
Coria
ndrumsativ
umL
Apiaceae
Dhania
HA
CF
Fruitisc
rushed
andmixed
with
saltas
carm
inativeindigestion
Smallamou
ntof
safoof
2tim
esa
day
Smallamou
ntof
safoof
2tim
esa
day
DIK
han
CrotalariaburhiaBe
nth
Papilio
naceae
Sassai
SP
WWhpl
Drie
dplantisg
roun
dmixed
with
waterand
strainedandis
givenlocally
ford
iarrheaa
ndothera
bdom
inaltro
ubles
DIK
han
Curcum
alonga
LZing
iberaceae
Haldi
HA
CRh
Rhizom
epow
derise
ffectivein
stomachcancerstomach
bleeding
Not
used
still
Asn
eeded
Kohat
Cyperusr
otun
dusL
Cy
peraceae
Delloca
HP
WRh
Rhizom
eise
ffectiveintre
atment
ofdyspepsia
diarrheaa
ndvomiting
Asn
eeded
Asn
eeded
Bann
u
Daturastra
monium
LSolanaceae
Datura
HA
WWhpl
Seedsa
reused
forintestin
alworms
Asn
eeded
Asn
eeded
Karak
Elaeagnu
sangustifoliaL
Cactaceae
Sersang
TP
WR
SF
Con
stipatio
nLakk
iMarwat
Ephedrag
erardian
aWallex
StapfEp
hedraceae
Somane
TA
CW
ShFL
Dyspepsia
Lakk
iMarwat
EquisetumarvenseL
Eq
uisetaceae
Horsta
ilCh
ihly
HP
WWhpl
Diarrhea
Lakk
iMarwat
BioMed Research International 7
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Eugeniajambolana
Lam
Myrtaceae
Jaman
TP
CS
Forstomachprob
lemsgrindthe
seedsa
ndmakep
owder
Asn
eeded
1-2spoo
nsdaily
for3
days
Bann
u
Euphorbiah
irtaL
Euph
orbiaceae
Titra
HP
WWhpl
Stom
achpain
Lakk
iMarwat
FicusreligiosaL
Moraceae
Peepal
TP
WC
BaBu
rntheb
arkandmakep
owder
from
itTake
5gram
sofito
rally
with
water
ford
iarrhea
Asn
eeded
Asn
eeded
Bann
u
Foenicu
lumvulga
reMill
Apiaceae
Saun
fH
AC
F
Equalquantity
offenn
elfruit
coria
nder
fruitAn
ethu
msowa
andsugara
remixed
andgrou
ndtogether
tomakep
owderfor
dyspepsia
andabdo
minalpain
Asrequired
Twicea
dayaft
ermeal
DIK
han
Fumariaindica
(Hausskn
)Pu
gsley
Fumariaceae
Shahtera
HP
WWhpl
Itisused
inachesa
ndpains
diarrheavom
iting
Asn
eeded
Asn
eeded
Kohat
Lyciu
mbarbarum
LSolanaceae
SP
WL
Extractfrom
leaves
iseffectiv
ein
curin
gbloo
dydiarrhea
and
vomiting
Asn
eeded
Asn
eeded
Bann
u
Malva
negle
ctaWallr
Malvaceae
Panerak
HP
WSh
Stom
achpain
Lakk
iMarwat
Malva
parvifloraL
Malvaceae
Puskay
HP
WL
Decoctio
nof
leaves
isused
for
stomachprob
lemItisa
lsoused
aslaxativ
eNot
used
Asneeded
Karak
Meliaa
zadirachtaL
Meliaceae
DharekBa
kain
TP
CW
LF
Leaves
andfruitd
ecoctio
nis
used
toremoveintestin
alworms
Littlea
mou
ntis
given
more
dosage
cause
vomiting
Asn
eededmore
dosage
cause
vomiting
Lakk
iMarwat
Menthalongifolia
(L)L
Lamiaceae
Villanaypo
dina
HA
CWhpl
Freshleaves
areb
oiledin
water
with
greenteam
ixed
somes
ugar
tocure
diarrhea
2teas
poon
safte
r3ho
ursfor
1day
4teas
poon
safte
r3ho
ursfor
1day
Kohat
Lakk
iMarwat
KarakDI
Khan
Nastu
rtium
officin
aleR
Br
Brassic
aceae
Term
era
HP
WWhpl
Leaves
aretaken
orallyfor
constip
ation
Asn
eeded
Asn
eeded
DIK
han
Opuntiadillenii(Ke
rGaw
l)Haw
Cactaceae
Kund
athu
rS
PW
LF
Ripenedfruitisb
oiledin
water
addsomes
ugar
andtake
orally
forc
onstipatio
nAsn
eeded
Asn
eeded
DIK
han
Opu
ntiamonacantha(W
illd)
Haw
Cactaceae
Chnu
tarthar
SP
WWhpl
Digestio
nhelp
DIK
han
Oxalis
cornicu
lata
LOxalid
aceae
Tarookay
HP
WL
Extractjuice
from
fresh
leaves
useo
rally
againststomach
troub
les
Asn
eeded
Asn
eeded
Bann
u
8 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Phyllanthus
emblica
Phyllanthaceae
Amla
TP
WF
Effectiv
eindiarrhea
dysentery
Kohat
Punica
granatum
LPu
nicaceae
Anar
TP
CF
Outer
coverin
gof
fruitisd
ried
andcrushedandpo
wderistaken
with
water
ford
iarrhea
One
tables
poon
daily
for2
-3days
One
tables
poon
daily
for2
-3days
DIK
han
Rosaindica
LRo
saceae
Gulab
SP
CFl
Flow
erarem
ixed
with
sugarp
utin
sunplacetakeo
rally
with
water
andfenn
elforv
omiting
anddyspepsia
2gtwicea
day
5gtwicea
day
DIK
han
Bann
uKo
hat
Saccharumoffi
cinarum
LPo
aceae
Gana
SA
CSt
Stem
extractisu
sefulin
indigestion
Twicea
day
Twicea
day
DIK
han
Lakk
iMarwat
Bann
uSisymbriumirioLinn
Brassic
aceae
Shon
opy
HA
WL
Leaves
areu
sedforstomach
prob
lems
Asn
eeded
Asn
eeded
Karak
Solanu
msuratte
nseB
urmF
Solanaceae
Manragh
onay
HB
WF
Fruitisd
riedcrushedand
powderistaken
fora
bdom
enpain
andgastroub
leAsn
eeded
Asn
eeded
Bann
uKo
hat
Tordylium
nodosum
LAp
iaceae
Hosobeta
HA
WWhpl
Intestinalw
orms
Bann
u
With
ania
coagulan
s(Stocks)
Dun
alSolanaceae
KhapyangaPaneer
HA
WFL
Fruitsarec
rushedm
ixwith
salt
andtake
orallywith
water
for
gastric
andabdo
minalpain
Fruitsares
tained
inwater
and
taken
Extracto
fleavesisu
sed
Twicea
dayfor
2-3days
Thric
eadayfor
3-4days
Karak
KohatD
IKhan
Lakk
iMarwat
Bann
uWoodfordiafru
ticosa(L)Ku
rzLythraceae
Dhawai
SP
WC
FlItisused
indiarrheadysentery
ulcersand
UTI
Kohat
Zizip
husjujub
aMill
Rham
naceae
Jang
libera
TP
WC
F
Roastthe
fruitand
eatfor
the
treatmento
fstomachprob
lems
Take
5gram
sofroo
tpow
dera
nd7pieces
ofblackpepp
ergrin
dandmixused
tocure
diarrhea
andabdo
minalpain
Smallamou
nttwicea
day
400m
gthric
eadayfor3
days
Bann
uD
IKhan
Lakk
iMarwat
Zizip
husn
ummularia
(Burmf)Wight
ampArn
Rham
naceae
Bair
TP
CF
Decoctio
nof
leaves
andbark
isused
indysentery
Asn
eeded
Take
orallythric
ead
ayfor3
-4days
Bann
uD
IKhan
Kohat
Ttre
eSshrubHherbPperenn
ialA
ann
ualB
bienn
ialW
wild
Ccultiv
atedFfruitLleavesFlflo
werW
hPlw
holeplantStstemShshoo
tBa
barkSseedR
roo
tRh
rhizomePo
pod
sandBu
bulb
BioMed Research International 9
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
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[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
Shigella spp Salmonella spp Aeromonas spp Pseudomonasspp Campylobacter spp Klebsiella spp and Staphylococcusaureus [10] However antibiotic resistance is a major clinicalproblem in treating infections caused by these microor-ganisms Synthetic drugs such as proton pump inhibitorsH2 receptors cytoprotectants demulcents anticholinergicsantacids and prostaglandin analogues are used for the treat-ment of gastro problems but these drugs produce several sideeffects Herbal remedies are considered as better alternativesfor the treatment For example proton pump inhibitors(omeprazole lansoprazole) may cause nausea abdominalpain constipation and diarrhea and H2 receptor antagonists(cimetidine)may cause gynaecomastia and loss of libido Dueto the occurrence of many side effects by use of syntheticdrugs for many diseases medicinal plants are considered asthe main source of new drugs as they have less or no sideeffects Herbal medicines are considered as safe with lesseradverse effects economical effective relatively less toxic andextensive research is carried out in search for potent drugs ofplant origin [11] In Pakistan and other countries a variety ofmedicinal plants are used against gastrointestinal complaintssuch as diarrhea dysentery and cholera However manyof them have not been screened for their phytochemistryand pharmacological action against microbes which couldsupport their use in traditional medicines
The present study was the first effort to target gastroin-testinal infections and their traditional recipes in five remotesouthern regions of Khyber Pakhtunkhwa province of Pak-istan where these infections were found more common Themain purpose of the study was to conserve the ethnomedic-inal knowledge and to select candidate medicinal plants forfurther phytochemical and pharmacological investigationThe available literature shows that such studies can constitutethe starting point for the development of new drugs [12 13]Our efforts are towards not only providing nutrition andhealth care to the people but also recovering record anddiffuse local botanical knowledge and traditional wisdom
2 Material and Methods21 Study Area The present study was conducted in fivemajor remote areas (Dera Ismail Khan Bannu LakkiMarwatand Karak and Kohat) of Khyber Pakhtunkhwa province ofPakistan (Figure 1) D I Khan is an area of 7326 squarekilometers and is situated between 31∘151015840 and 32∘321015840N latitudeand between 70∘111015840 and 71∘201015840E longitude Most of the areaof D I Khan is flat dry alluvial plains supporting mostlyxerophytic vegetation Dominant plant species are Acaciamodesta Acacia nilotica Calotropis procera Morus albaand Eucalyptus camaldulensis Most of the population ofthe area is rural with low literacy rate and they also lackmodern health facilities hence they are more dependentupon natural resources especially plants for their healthcareand to compensate their low income as well [14] Bannuconsists of a total area of 877 square kilometers with apopulation of 19593 It lies within the Karakoram mountainrange between 32∘43 to 33∘06N latitude and 73∘20 to 70∘07Elongitude The total cultivated area is about 33000 acreswith wheat maize and sugarcane being the main cultivated
crops About 25 of the inhabitants of the area as well asAfghan refugees are engaged in the collection and marketingof medicinal plantsThe area consists of alluvial plain with anannual rainfall of 11136mm The dominant plant species areAcaciamodestaAcacia niloticaCalotropis proceraDodonaeaviscosa andWithania somnifera [15] Karak region is situatedin the south of KPK with total area of 600 square kilometersand lies between 70-40∘ to 71-30∘N latitude and 32-48∘ to 33-23∘E longitude The study area is divided into mountainousarea small hills and plains having most of clayey or sandysoil Wheat corn and gram are the common cultivatedcrops Various plant species dominated the study area suchas Acacia modesta Acacia nilotica Adhatoda vasica Aervajavanica Dodonaea viscosa Eucalyptus lanceolatus Fagoniacretica Rhazya stricta Saccharum arundinaceum Withaniacoagulans and Withania somnifera [16] Kohat is located at33∘35101584013N 71∘26101584029E with an altitude of 489m above sealevel The dominant vegetation of the study area is Zizyphusspecies Acacia species and other xerophytes plants The areais rural in nature and inhabitants are very much dependenton plants for agricultural economic and food purposesLocals of the region use a variety of medicinal plants for thetreatment of various ailments due to expensivemodern drugs[17] Lakki Marwat is situated between 32∘161N latitude and70∘191E longitude at altitude of 200ndash1000m above sea levelThis district covers an area of 3164 km2 with a cultivated areaof approximately 116900 ha The indigenous people of thedistrict are Marwat tribes but a small proportion of othertribes also settled here Transport and minerals are the mainsources of economy in the urban area and agriculture is theprimary livelihood of the rural population The major ethnicgroup in this district speaks Pashto (993) which is spokenin a specific dialect [18] The remaining population speaksPunjabi (07) in Hindko dialect
22 Sampling and Data Collection Data collection was car-ried out from 2013 to 2014 Prior to data collection localadministrative officers of the regions were visited and it wasexplained them themain idea of the study in order to get theirpermission According to the information provided by thelocal administrative officers 350 respondents were selectedin five studied region with 70 informants in each regionThe selection criterion of informants was mainly based ontheir rich indigenous knowledge and long term experienceof utilization of plants as well as their living period of timein the study area Selected respondents of the regions wereaged between 30 and 79 years Verbal consent includingconsent for publication was received from all the informantsbefore the interviews began The informants are aware thatthe information they have provided will be published andthat data will be used only for scientific purposes Data wascollected in local language (Saraiki Hindko and Pashto) andconverted into English Semistructured questionnaires weredesigned to collect ethnomedicinal knowledge of medicinalplants used against gastrointestinal infections
23 Plants Collection and Identification Plants were collectedwith the help of respondents from wild and cultivated areasCollected voucher specimens were taken to the Herbarium
BioMed Research International 3
Afghanistan
Charikar
Jalalabad
Khyber Agency
Kabul
Gardeyz
Khowst
SharZarghun North
SouthWaziristan
Balochistan
WaziristanRazmak
Miranshah
Wana
Jandola
LakkiMarwat
Tank
Zhob
Dera IsmailKhan
Dera
KhanIsmail
Bannu
Karak
Hangu
KurramAgency
ParachinarLandi
MohmandAgency
Kotal
Orakzai Agency
KohatKohat
Mianwali
Kalabagh
Panjab
Pakistan
Islamabad
Murree
India
BajaurAgency
DirDir
Swat
Shangla
Mansehra
Chitral
Chitral
Mastuj
Mt Tirich MirMor Khun
Northern Areas
Gilgit
AgencyMalakand
Nowshera
Charsadda
Peshawar
MardanSwabi
Buner
HaripurAbbottabad
Tajikistan
Kalam DasuKohistan
SaiduSharif
Naran
MansehraBattagram
Figure 1
of Kohat University of Science and Technology (KUST)Kohat Pakistan Specimen identification and confirmationwere undertaken by using Flora of Pakistan and taxonomicexperts Specimens with their label were stored at theHerbar-ium of KUST Kohat Pakistan
24 Data Organization The collected data on ethno medic-inal plants and ethnography of the respondents was orga-nized using Microsoft Excel 2007 and summarized usinggraphical statistical methods such as percentages The habitof the plants was categorized into 3 classes (herbs shrubsand trees) Life form of medicinal plants was classified
into annual biennial and perennial Plant parts use wascategorized into leaves roots stem whole plant seedsfruit and flower Stomach disorders were divided into sixmajor categories that is diarrhea dysentery abdominal painintestinal worms constipation and nausea and vomiting
25 Data Quality Assurance Each respondent was ap-proached at least three times during data collection for 5 thelegitimacy of information they provided Information wasconsidered irrelevant and rejected in case of any divergencefrom the original information of the respondent Valid datawas only subjected to further analysis process Further data
4 BioMed Research International
quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis
26 Data Analysis
261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows
Fic = nur minus ntnur minus 1
(1)
where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used
262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula
FL = IpIutimes 100 (2)
where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]
3 Results
In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred
plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)
Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)
Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives
4 Discussion
41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]
42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs
BioMed Research International 5Ta
ble1Medicinaluses
ofplantsforstomachtro
ubles
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Abutilonindicum
(L)Sw
eet
Malvaceae
Koso
beta
SA
WWhpl
Decoctio
nor
powderisu
sed
againstcon
stipatio
n1tea
spoo
naft
ermeal
2ndash4teas
poon
saft
ermeal
Lakk
iMarwat
Acaciamodesta
Wall
Mim
osaceae
Phulahi
TP
WBa
Decoctio
nismadeb
ybo
iling
bark
inwater
orpo
wdero
fbark
ismadeb
ygrinding
theb
arkfor
treatmento
fgas
troub
leand
abdo
minaldiseases
2spoo
nsaft
er4h
rsfor1
day
3-4spoo
nsaft
er2h
rsfor2
days
ordepend
son
severity
DIK
han
Acacianilotica(L)Delile
Mim
osaceae
Kikar
TP
WPo
Ba
Decoctio
nof
theb
arkisused
indiarrhea
andpo
dsareg
rindedto
makep
owderm
ixed
with
sugar
orho
neyto
treatdysentery
Smallamou
ntof
powderisg
iven
for1-2
days
500m
ggiven
twicea
dayfor3
days
Kohat
Achyranthesa
speraL
Amaranthaceae
Gho
shkai
HP
WWhpl
Itsdecoctionisused
insto
mach
disorderTh
ejuice
ofthep
lant
isused
inabdo
minalpain
dysenteryandin
bowel
complaints
Depends
ondiseases
everity
Depends
ondiseases
everity
Bann
u
Albizialebbeck
(L)Be
nth
Mim
osaceae
Sirin
TP
CBa
Bark
decoctionisused
totre
atdiarrhea
1-2spoo
n3tim
esad
ay1-2
spoo
naft
er3h
rsfor1
day
Bann
u
Alliu
mcepa
LLiliaceae
Piaz
HA
CBu
Equalamou
ntso
fextractof
onionbu
lbandmintare
mixed
andgivenforc
holera
Halftea
spoo
nof
thismixture
istakenperh
our
fora
perio
das
needed
One
teas
poon
ofthismixture
istakenperh
our
fora
perio
das
needed
DIK
han
Argyrolobium
roseum
(Cam
bess)
Jaub
ampSpach
Nyctaginaceae
Muk
hanBu
tti
SB
WWhpl
Diarrhea
Bann
u
Artemisiaa
bsinthium
LAs
teraceae
Afsanteen
HB
WL
Leaves
areb
oiledto
expel
intestinalwormsindigestion
diarrheaand
vomiting
Asn
eeded
Asn
eeded
Kohat
Asparagusadscend
ensR
oxb
Asparagaceae
Safid
muesli
HA
WR
Groun
droot
iseffectiv
efor
carm
inative
Asn
eeded
Asn
eeded
Karak
Azadira
chta
indica
AJuss
Meliaceae
Neem
TP
CL
Decoctio
nof
leaves
istakenfor
digestivea
ndgastric
prob
lems
2teas
poon
sfor
oned
ay2teas
poon
sfor
oned
ay
DIK
han
Lakk
iMarwat
Bisto
rtaam
plexica
ulis(D
Don
)Greene
Polygonaceae
Masloon
Anjabar
HP
WWhpl
Con
stipatio
nBa
nnu
Kohat
Boerhaavia
diffu
saBrandegee
Nyctaginaceae
Punara
HP
WR
Gas
troub
les
Karak
Camelliasin
ensis
(green
tea)
LKu
ntze
Theaceae
Sabz
pati
HP
CL
Leaves
areb
oiledin
water
mixed
somes
ugar
andtake
orallyfor
indigestionandnausea
1orh
alfcup
once
aday
1cup
aday
DIK
han
Bann
uLakk
iMarwat
6 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Carissa
opacaStapfex
Haines
Apocyn
aceae
Grand
aS
AWC
LR
FDysentery
Karak
Carumcopticu
m(L)Be
nthamp
Hoo
kfex
CB
Clarke
Umbelliferae
Spaerkae
HA
CS
Usedin
sore
throatdiarrhea
dysenteryandvomiting
Kohat
Cassiafi
stula
LCa
esalpiniaceae
Amaltas
TP
CF
Apieceo
fthe
fruitcon
taining
10ndash12seedsa
reslightly
grou
ndandbo
iledin
12liter
ofwater
andstr
ainedford
ysentery
1-2teas
poon
s3tim
esdaily
for1-2
days
3-4teas
poon
s3-4tim
esdaily
DIK
han
Bann
u
Cedrus
deodara(Roxbex
D
Don
)GD
onPinaceae
Diar
TA
CWhpl
Gas
troub
les
Karak
Cinn
amom
umzeylanicu
mBlum
eLauraceae
Dalchini
TP
CBa
Bark
powdera
nddecoctionis
used
ingastrointestinaldisorder
vomiting
dysenteryand
diarrhea
Asn
eeded
Asn
eeded
Kohat
Citru
lluscolocynthis(L)Schrad
Cucurbita
ceae
Kartum
ma
HA
WF
Fruitisc
utboiledin
water
and
sugara
dded
tomakem
urabba
used
forc
onstipatio
nand
abdo
minaldiseases
Asn
eeded
Asn
eeded
DIK
han
Bann
uKo
hat
Lakk
iMarwat
Coria
ndrumsativ
umL
Apiaceae
Dhania
HA
CF
Fruitisc
rushed
andmixed
with
saltas
carm
inativeindigestion
Smallamou
ntof
safoof
2tim
esa
day
Smallamou
ntof
safoof
2tim
esa
day
DIK
han
CrotalariaburhiaBe
nth
Papilio
naceae
Sassai
SP
WWhpl
Drie
dplantisg
roun
dmixed
with
waterand
strainedandis
givenlocally
ford
iarrheaa
ndothera
bdom
inaltro
ubles
DIK
han
Curcum
alonga
LZing
iberaceae
Haldi
HA
CRh
Rhizom
epow
derise
ffectivein
stomachcancerstomach
bleeding
Not
used
still
Asn
eeded
Kohat
Cyperusr
otun
dusL
Cy
peraceae
Delloca
HP
WRh
Rhizom
eise
ffectiveintre
atment
ofdyspepsia
diarrheaa
ndvomiting
Asn
eeded
Asn
eeded
Bann
u
Daturastra
monium
LSolanaceae
Datura
HA
WWhpl
Seedsa
reused
forintestin
alworms
Asn
eeded
Asn
eeded
Karak
Elaeagnu
sangustifoliaL
Cactaceae
Sersang
TP
WR
SF
Con
stipatio
nLakk
iMarwat
Ephedrag
erardian
aWallex
StapfEp
hedraceae
Somane
TA
CW
ShFL
Dyspepsia
Lakk
iMarwat
EquisetumarvenseL
Eq
uisetaceae
Horsta
ilCh
ihly
HP
WWhpl
Diarrhea
Lakk
iMarwat
BioMed Research International 7
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Eugeniajambolana
Lam
Myrtaceae
Jaman
TP
CS
Forstomachprob
lemsgrindthe
seedsa
ndmakep
owder
Asn
eeded
1-2spoo
nsdaily
for3
days
Bann
u
Euphorbiah
irtaL
Euph
orbiaceae
Titra
HP
WWhpl
Stom
achpain
Lakk
iMarwat
FicusreligiosaL
Moraceae
Peepal
TP
WC
BaBu
rntheb
arkandmakep
owder
from
itTake
5gram
sofito
rally
with
water
ford
iarrhea
Asn
eeded
Asn
eeded
Bann
u
Foenicu
lumvulga
reMill
Apiaceae
Saun
fH
AC
F
Equalquantity
offenn
elfruit
coria
nder
fruitAn
ethu
msowa
andsugara
remixed
andgrou
ndtogether
tomakep
owderfor
dyspepsia
andabdo
minalpain
Asrequired
Twicea
dayaft
ermeal
DIK
han
Fumariaindica
(Hausskn
)Pu
gsley
Fumariaceae
Shahtera
HP
WWhpl
Itisused
inachesa
ndpains
diarrheavom
iting
Asn
eeded
Asn
eeded
Kohat
Lyciu
mbarbarum
LSolanaceae
SP
WL
Extractfrom
leaves
iseffectiv
ein
curin
gbloo
dydiarrhea
and
vomiting
Asn
eeded
Asn
eeded
Bann
u
Malva
negle
ctaWallr
Malvaceae
Panerak
HP
WSh
Stom
achpain
Lakk
iMarwat
Malva
parvifloraL
Malvaceae
Puskay
HP
WL
Decoctio
nof
leaves
isused
for
stomachprob
lemItisa
lsoused
aslaxativ
eNot
used
Asneeded
Karak
Meliaa
zadirachtaL
Meliaceae
DharekBa
kain
TP
CW
LF
Leaves
andfruitd
ecoctio
nis
used
toremoveintestin
alworms
Littlea
mou
ntis
given
more
dosage
cause
vomiting
Asn
eededmore
dosage
cause
vomiting
Lakk
iMarwat
Menthalongifolia
(L)L
Lamiaceae
Villanaypo
dina
HA
CWhpl
Freshleaves
areb
oiledin
water
with
greenteam
ixed
somes
ugar
tocure
diarrhea
2teas
poon
safte
r3ho
ursfor
1day
4teas
poon
safte
r3ho
ursfor
1day
Kohat
Lakk
iMarwat
KarakDI
Khan
Nastu
rtium
officin
aleR
Br
Brassic
aceae
Term
era
HP
WWhpl
Leaves
aretaken
orallyfor
constip
ation
Asn
eeded
Asn
eeded
DIK
han
Opuntiadillenii(Ke
rGaw
l)Haw
Cactaceae
Kund
athu
rS
PW
LF
Ripenedfruitisb
oiledin
water
addsomes
ugar
andtake
orally
forc
onstipatio
nAsn
eeded
Asn
eeded
DIK
han
Opu
ntiamonacantha(W
illd)
Haw
Cactaceae
Chnu
tarthar
SP
WWhpl
Digestio
nhelp
DIK
han
Oxalis
cornicu
lata
LOxalid
aceae
Tarookay
HP
WL
Extractjuice
from
fresh
leaves
useo
rally
againststomach
troub
les
Asn
eeded
Asn
eeded
Bann
u
8 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Phyllanthus
emblica
Phyllanthaceae
Amla
TP
WF
Effectiv
eindiarrhea
dysentery
Kohat
Punica
granatum
LPu
nicaceae
Anar
TP
CF
Outer
coverin
gof
fruitisd
ried
andcrushedandpo
wderistaken
with
water
ford
iarrhea
One
tables
poon
daily
for2
-3days
One
tables
poon
daily
for2
-3days
DIK
han
Rosaindica
LRo
saceae
Gulab
SP
CFl
Flow
erarem
ixed
with
sugarp
utin
sunplacetakeo
rally
with
water
andfenn
elforv
omiting
anddyspepsia
2gtwicea
day
5gtwicea
day
DIK
han
Bann
uKo
hat
Saccharumoffi
cinarum
LPo
aceae
Gana
SA
CSt
Stem
extractisu
sefulin
indigestion
Twicea
day
Twicea
day
DIK
han
Lakk
iMarwat
Bann
uSisymbriumirioLinn
Brassic
aceae
Shon
opy
HA
WL
Leaves
areu
sedforstomach
prob
lems
Asn
eeded
Asn
eeded
Karak
Solanu
msuratte
nseB
urmF
Solanaceae
Manragh
onay
HB
WF
Fruitisd
riedcrushedand
powderistaken
fora
bdom
enpain
andgastroub
leAsn
eeded
Asn
eeded
Bann
uKo
hat
Tordylium
nodosum
LAp
iaceae
Hosobeta
HA
WWhpl
Intestinalw
orms
Bann
u
With
ania
coagulan
s(Stocks)
Dun
alSolanaceae
KhapyangaPaneer
HA
WFL
Fruitsarec
rushedm
ixwith
salt
andtake
orallywith
water
for
gastric
andabdo
minalpain
Fruitsares
tained
inwater
and
taken
Extracto
fleavesisu
sed
Twicea
dayfor
2-3days
Thric
eadayfor
3-4days
Karak
KohatD
IKhan
Lakk
iMarwat
Bann
uWoodfordiafru
ticosa(L)Ku
rzLythraceae
Dhawai
SP
WC
FlItisused
indiarrheadysentery
ulcersand
UTI
Kohat
Zizip
husjujub
aMill
Rham
naceae
Jang
libera
TP
WC
F
Roastthe
fruitand
eatfor
the
treatmento
fstomachprob
lems
Take
5gram
sofroo
tpow
dera
nd7pieces
ofblackpepp
ergrin
dandmixused
tocure
diarrhea
andabdo
minalpain
Smallamou
nttwicea
day
400m
gthric
eadayfor3
days
Bann
uD
IKhan
Lakk
iMarwat
Zizip
husn
ummularia
(Burmf)Wight
ampArn
Rham
naceae
Bair
TP
CF
Decoctio
nof
leaves
andbark
isused
indysentery
Asn
eeded
Take
orallythric
ead
ayfor3
-4days
Bann
uD
IKhan
Kohat
Ttre
eSshrubHherbPperenn
ialA
ann
ualB
bienn
ialW
wild
Ccultiv
atedFfruitLleavesFlflo
werW
hPlw
holeplantStstemShshoo
tBa
barkSseedR
roo
tRh
rhizomePo
pod
sandBu
bulb
BioMed Research International 9
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
of Kohat University of Science and Technology (KUST)Kohat Pakistan Specimen identification and confirmationwere undertaken by using Flora of Pakistan and taxonomicexperts Specimens with their label were stored at theHerbar-ium of KUST Kohat Pakistan
24 Data Organization The collected data on ethno medic-inal plants and ethnography of the respondents was orga-nized using Microsoft Excel 2007 and summarized usinggraphical statistical methods such as percentages The habitof the plants was categorized into 3 classes (herbs shrubsand trees) Life form of medicinal plants was classified
into annual biennial and perennial Plant parts use wascategorized into leaves roots stem whole plant seedsfruit and flower Stomach disorders were divided into sixmajor categories that is diarrhea dysentery abdominal painintestinal worms constipation and nausea and vomiting
25 Data Quality Assurance Each respondent was ap-proached at least three times during data collection for 5 thelegitimacy of information they provided Information wasconsidered irrelevant and rejected in case of any divergencefrom the original information of the respondent Valid datawas only subjected to further analysis process Further data
4 BioMed Research International
quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis
26 Data Analysis
261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows
Fic = nur minus ntnur minus 1
(1)
where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used
262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula
FL = IpIutimes 100 (2)
where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]
3 Results
In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred
plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)
Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)
Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives
4 Discussion
41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]
42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs
BioMed Research International 5Ta
ble1Medicinaluses
ofplantsforstomachtro
ubles
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Abutilonindicum
(L)Sw
eet
Malvaceae
Koso
beta
SA
WWhpl
Decoctio
nor
powderisu
sed
againstcon
stipatio
n1tea
spoo
naft
ermeal
2ndash4teas
poon
saft
ermeal
Lakk
iMarwat
Acaciamodesta
Wall
Mim
osaceae
Phulahi
TP
WBa
Decoctio
nismadeb
ybo
iling
bark
inwater
orpo
wdero
fbark
ismadeb
ygrinding
theb
arkfor
treatmento
fgas
troub
leand
abdo
minaldiseases
2spoo
nsaft
er4h
rsfor1
day
3-4spoo
nsaft
er2h
rsfor2
days
ordepend
son
severity
DIK
han
Acacianilotica(L)Delile
Mim
osaceae
Kikar
TP
WPo
Ba
Decoctio
nof
theb
arkisused
indiarrhea
andpo
dsareg
rindedto
makep
owderm
ixed
with
sugar
orho
neyto
treatdysentery
Smallamou
ntof
powderisg
iven
for1-2
days
500m
ggiven
twicea
dayfor3
days
Kohat
Achyranthesa
speraL
Amaranthaceae
Gho
shkai
HP
WWhpl
Itsdecoctionisused
insto
mach
disorderTh
ejuice
ofthep
lant
isused
inabdo
minalpain
dysenteryandin
bowel
complaints
Depends
ondiseases
everity
Depends
ondiseases
everity
Bann
u
Albizialebbeck
(L)Be
nth
Mim
osaceae
Sirin
TP
CBa
Bark
decoctionisused
totre
atdiarrhea
1-2spoo
n3tim
esad
ay1-2
spoo
naft
er3h
rsfor1
day
Bann
u
Alliu
mcepa
LLiliaceae
Piaz
HA
CBu
Equalamou
ntso
fextractof
onionbu
lbandmintare
mixed
andgivenforc
holera
Halftea
spoo
nof
thismixture
istakenperh
our
fora
perio
das
needed
One
teas
poon
ofthismixture
istakenperh
our
fora
perio
das
needed
DIK
han
Argyrolobium
roseum
(Cam
bess)
Jaub
ampSpach
Nyctaginaceae
Muk
hanBu
tti
SB
WWhpl
Diarrhea
Bann
u
Artemisiaa
bsinthium
LAs
teraceae
Afsanteen
HB
WL
Leaves
areb
oiledto
expel
intestinalwormsindigestion
diarrheaand
vomiting
Asn
eeded
Asn
eeded
Kohat
Asparagusadscend
ensR
oxb
Asparagaceae
Safid
muesli
HA
WR
Groun
droot
iseffectiv
efor
carm
inative
Asn
eeded
Asn
eeded
Karak
Azadira
chta
indica
AJuss
Meliaceae
Neem
TP
CL
Decoctio
nof
leaves
istakenfor
digestivea
ndgastric
prob
lems
2teas
poon
sfor
oned
ay2teas
poon
sfor
oned
ay
DIK
han
Lakk
iMarwat
Bisto
rtaam
plexica
ulis(D
Don
)Greene
Polygonaceae
Masloon
Anjabar
HP
WWhpl
Con
stipatio
nBa
nnu
Kohat
Boerhaavia
diffu
saBrandegee
Nyctaginaceae
Punara
HP
WR
Gas
troub
les
Karak
Camelliasin
ensis
(green
tea)
LKu
ntze
Theaceae
Sabz
pati
HP
CL
Leaves
areb
oiledin
water
mixed
somes
ugar
andtake
orallyfor
indigestionandnausea
1orh
alfcup
once
aday
1cup
aday
DIK
han
Bann
uLakk
iMarwat
6 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Carissa
opacaStapfex
Haines
Apocyn
aceae
Grand
aS
AWC
LR
FDysentery
Karak
Carumcopticu
m(L)Be
nthamp
Hoo
kfex
CB
Clarke
Umbelliferae
Spaerkae
HA
CS
Usedin
sore
throatdiarrhea
dysenteryandvomiting
Kohat
Cassiafi
stula
LCa
esalpiniaceae
Amaltas
TP
CF
Apieceo
fthe
fruitcon
taining
10ndash12seedsa
reslightly
grou
ndandbo
iledin
12liter
ofwater
andstr
ainedford
ysentery
1-2teas
poon
s3tim
esdaily
for1-2
days
3-4teas
poon
s3-4tim
esdaily
DIK
han
Bann
u
Cedrus
deodara(Roxbex
D
Don
)GD
onPinaceae
Diar
TA
CWhpl
Gas
troub
les
Karak
Cinn
amom
umzeylanicu
mBlum
eLauraceae
Dalchini
TP
CBa
Bark
powdera
nddecoctionis
used
ingastrointestinaldisorder
vomiting
dysenteryand
diarrhea
Asn
eeded
Asn
eeded
Kohat
Citru
lluscolocynthis(L)Schrad
Cucurbita
ceae
Kartum
ma
HA
WF
Fruitisc
utboiledin
water
and
sugara
dded
tomakem
urabba
used
forc
onstipatio
nand
abdo
minaldiseases
Asn
eeded
Asn
eeded
DIK
han
Bann
uKo
hat
Lakk
iMarwat
Coria
ndrumsativ
umL
Apiaceae
Dhania
HA
CF
Fruitisc
rushed
andmixed
with
saltas
carm
inativeindigestion
Smallamou
ntof
safoof
2tim
esa
day
Smallamou
ntof
safoof
2tim
esa
day
DIK
han
CrotalariaburhiaBe
nth
Papilio
naceae
Sassai
SP
WWhpl
Drie
dplantisg
roun
dmixed
with
waterand
strainedandis
givenlocally
ford
iarrheaa
ndothera
bdom
inaltro
ubles
DIK
han
Curcum
alonga
LZing
iberaceae
Haldi
HA
CRh
Rhizom
epow
derise
ffectivein
stomachcancerstomach
bleeding
Not
used
still
Asn
eeded
Kohat
Cyperusr
otun
dusL
Cy
peraceae
Delloca
HP
WRh
Rhizom
eise
ffectiveintre
atment
ofdyspepsia
diarrheaa
ndvomiting
Asn
eeded
Asn
eeded
Bann
u
Daturastra
monium
LSolanaceae
Datura
HA
WWhpl
Seedsa
reused
forintestin
alworms
Asn
eeded
Asn
eeded
Karak
Elaeagnu
sangustifoliaL
Cactaceae
Sersang
TP
WR
SF
Con
stipatio
nLakk
iMarwat
Ephedrag
erardian
aWallex
StapfEp
hedraceae
Somane
TA
CW
ShFL
Dyspepsia
Lakk
iMarwat
EquisetumarvenseL
Eq
uisetaceae
Horsta
ilCh
ihly
HP
WWhpl
Diarrhea
Lakk
iMarwat
BioMed Research International 7
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Eugeniajambolana
Lam
Myrtaceae
Jaman
TP
CS
Forstomachprob
lemsgrindthe
seedsa
ndmakep
owder
Asn
eeded
1-2spoo
nsdaily
for3
days
Bann
u
Euphorbiah
irtaL
Euph
orbiaceae
Titra
HP
WWhpl
Stom
achpain
Lakk
iMarwat
FicusreligiosaL
Moraceae
Peepal
TP
WC
BaBu
rntheb
arkandmakep
owder
from
itTake
5gram
sofito
rally
with
water
ford
iarrhea
Asn
eeded
Asn
eeded
Bann
u
Foenicu
lumvulga
reMill
Apiaceae
Saun
fH
AC
F
Equalquantity
offenn
elfruit
coria
nder
fruitAn
ethu
msowa
andsugara
remixed
andgrou
ndtogether
tomakep
owderfor
dyspepsia
andabdo
minalpain
Asrequired
Twicea
dayaft
ermeal
DIK
han
Fumariaindica
(Hausskn
)Pu
gsley
Fumariaceae
Shahtera
HP
WWhpl
Itisused
inachesa
ndpains
diarrheavom
iting
Asn
eeded
Asn
eeded
Kohat
Lyciu
mbarbarum
LSolanaceae
SP
WL
Extractfrom
leaves
iseffectiv
ein
curin
gbloo
dydiarrhea
and
vomiting
Asn
eeded
Asn
eeded
Bann
u
Malva
negle
ctaWallr
Malvaceae
Panerak
HP
WSh
Stom
achpain
Lakk
iMarwat
Malva
parvifloraL
Malvaceae
Puskay
HP
WL
Decoctio
nof
leaves
isused
for
stomachprob
lemItisa
lsoused
aslaxativ
eNot
used
Asneeded
Karak
Meliaa
zadirachtaL
Meliaceae
DharekBa
kain
TP
CW
LF
Leaves
andfruitd
ecoctio
nis
used
toremoveintestin
alworms
Littlea
mou
ntis
given
more
dosage
cause
vomiting
Asn
eededmore
dosage
cause
vomiting
Lakk
iMarwat
Menthalongifolia
(L)L
Lamiaceae
Villanaypo
dina
HA
CWhpl
Freshleaves
areb
oiledin
water
with
greenteam
ixed
somes
ugar
tocure
diarrhea
2teas
poon
safte
r3ho
ursfor
1day
4teas
poon
safte
r3ho
ursfor
1day
Kohat
Lakk
iMarwat
KarakDI
Khan
Nastu
rtium
officin
aleR
Br
Brassic
aceae
Term
era
HP
WWhpl
Leaves
aretaken
orallyfor
constip
ation
Asn
eeded
Asn
eeded
DIK
han
Opuntiadillenii(Ke
rGaw
l)Haw
Cactaceae
Kund
athu
rS
PW
LF
Ripenedfruitisb
oiledin
water
addsomes
ugar
andtake
orally
forc
onstipatio
nAsn
eeded
Asn
eeded
DIK
han
Opu
ntiamonacantha(W
illd)
Haw
Cactaceae
Chnu
tarthar
SP
WWhpl
Digestio
nhelp
DIK
han
Oxalis
cornicu
lata
LOxalid
aceae
Tarookay
HP
WL
Extractjuice
from
fresh
leaves
useo
rally
againststomach
troub
les
Asn
eeded
Asn
eeded
Bann
u
8 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Phyllanthus
emblica
Phyllanthaceae
Amla
TP
WF
Effectiv
eindiarrhea
dysentery
Kohat
Punica
granatum
LPu
nicaceae
Anar
TP
CF
Outer
coverin
gof
fruitisd
ried
andcrushedandpo
wderistaken
with
water
ford
iarrhea
One
tables
poon
daily
for2
-3days
One
tables
poon
daily
for2
-3days
DIK
han
Rosaindica
LRo
saceae
Gulab
SP
CFl
Flow
erarem
ixed
with
sugarp
utin
sunplacetakeo
rally
with
water
andfenn
elforv
omiting
anddyspepsia
2gtwicea
day
5gtwicea
day
DIK
han
Bann
uKo
hat
Saccharumoffi
cinarum
LPo
aceae
Gana
SA
CSt
Stem
extractisu
sefulin
indigestion
Twicea
day
Twicea
day
DIK
han
Lakk
iMarwat
Bann
uSisymbriumirioLinn
Brassic
aceae
Shon
opy
HA
WL
Leaves
areu
sedforstomach
prob
lems
Asn
eeded
Asn
eeded
Karak
Solanu
msuratte
nseB
urmF
Solanaceae
Manragh
onay
HB
WF
Fruitisd
riedcrushedand
powderistaken
fora
bdom
enpain
andgastroub
leAsn
eeded
Asn
eeded
Bann
uKo
hat
Tordylium
nodosum
LAp
iaceae
Hosobeta
HA
WWhpl
Intestinalw
orms
Bann
u
With
ania
coagulan
s(Stocks)
Dun
alSolanaceae
KhapyangaPaneer
HA
WFL
Fruitsarec
rushedm
ixwith
salt
andtake
orallywith
water
for
gastric
andabdo
minalpain
Fruitsares
tained
inwater
and
taken
Extracto
fleavesisu
sed
Twicea
dayfor
2-3days
Thric
eadayfor
3-4days
Karak
KohatD
IKhan
Lakk
iMarwat
Bann
uWoodfordiafru
ticosa(L)Ku
rzLythraceae
Dhawai
SP
WC
FlItisused
indiarrheadysentery
ulcersand
UTI
Kohat
Zizip
husjujub
aMill
Rham
naceae
Jang
libera
TP
WC
F
Roastthe
fruitand
eatfor
the
treatmento
fstomachprob
lems
Take
5gram
sofroo
tpow
dera
nd7pieces
ofblackpepp
ergrin
dandmixused
tocure
diarrhea
andabdo
minalpain
Smallamou
nttwicea
day
400m
gthric
eadayfor3
days
Bann
uD
IKhan
Lakk
iMarwat
Zizip
husn
ummularia
(Burmf)Wight
ampArn
Rham
naceae
Bair
TP
CF
Decoctio
nof
leaves
andbark
isused
indysentery
Asn
eeded
Take
orallythric
ead
ayfor3
-4days
Bann
uD
IKhan
Kohat
Ttre
eSshrubHherbPperenn
ialA
ann
ualB
bienn
ialW
wild
Ccultiv
atedFfruitLleavesFlflo
werW
hPlw
holeplantStstemShshoo
tBa
barkSseedR
roo
tRh
rhizomePo
pod
sandBu
bulb
BioMed Research International 9
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
quality was ensured through proper training of data collec-tors point out missing information duplication of materialand careful analysis
26 Data Analysis
261 Informant Consensus Factor (Fic) Fic was used forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and help in the selection of plantsfor pharmacological and phytochemical studies [19] Beforeusing this method diseases were classified into categories ashigh Fic plants are likely to be more pharmacologically activein comparison with low Fic value plants [20] Fic values liebetween ldquo000 and 100rdquo When single plant or few plants areused by large number of informants to cure a specific disorderscore high Fic values low Fic values give an indication thatinformants do not agree over which plant to use [21] The Ficcan be calculated using the formula as follows
Fic = nur minus ntnur minus 1
(1)
where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used
262 Fidelity Level (FL) Fidelity level (FL) is useful forrecognizing the most favored plants used for curing a specialailment by the respondents [22] FL values of highly preferredplants are greater than values of less preferred plants FLvalues are always calculated in terms of informantrsquos percent-age claiming the use of a definite plant species for the sameailment The FL values indicate the importance of certainplant species for particular purpose All of the reportedailments grouped into major classes for the calculation of FLvalues FL values were estimated by using the formula
FL = IpIutimes 100 (2)
where Ip represents the number of respondents who reportedthe medicinal plants utilization for a particular ailment andIu is the total number of respondents who mentioned thesame plant for any ailment It is assumed that thosemedicinalplants which are used frequently by most respondents for thesame category are more likely to be biologically active plants[23]
3 Results
In studied regions 52 plants belonging to 36 families (Table 1)were found to be used against gastrointestinal ailments DI Khan region contained high number of medicinal plants(19) for gastrointestinal ailments followed by Bannu (18)Kohat (15) LakkiMarwat (13) and Karak (8) Most dominantfamily used against gastrointestinal complaints was Apiaceae(4 plants) followed by Cactaceae Euphorbiaceae Malvaceaeand Rosaceae (3 plants each) and Meliaceae Brassicaceaeand Solanaceae (2 plants each) Fruit was the most preferred
plant part (24) used in herbal formulation followed bywhole plant (23) and leaves (19) (Table 2) Growth formindicated that herbs (50) were dominating followed bytrees (31) and shrubs (19) Gastrointestinal disorders weredivided into 6 major categories namely diarrhea dysenteryabdominal pain intestinal worms constipation nausea andvomiting Mostly wild plants (60) were used in studiedregions as compared to cultivated plants (40) Most of theherbal recipes were taken orally in decoction or powder formwith water salt and sugar It was observed that dosage of therecipe depends upon the age of the patient Recovery time ofthese formulationswas reported in range of 1ndash3 days (Table 1)
Fic values for gastrointestinal problems were estimated inrange of 086 to 092 Highest degree of informant consensuswas recorded for vomiting and nausea (092) abdominalpain (09) and diarrhea (089) The highest plant use citationwas recorded for abdominal pain (191) followed by diarrhea(151) (Table 3) The present study revealed seven potentialmedicinal plants scoring high FL valuesWithania coagulansranked first score highest FL value (86) followed byMenthalongifolia and Melia azadirachta (75 each) ranked secondCitrullus colocynthis ranked third with FL value (72) andRosa indica ranked fourth with (66) FL value (Table 4)
Demographic data showed highest degree of male infor-mants (57) followed by female (43) Majority of therespondents (100) interviewed were 40ndash49 years age rangefollowed by 50ndash59 (90) years old (Table 5) Large proportionof informants were illiterate (44) and themajor occupationsof male respondents in studied regions were farming shop-keeping and females were mostly house wives
4 Discussion
41 Medicinal Plants Diversity Natural sources remained aneffective method of treatments since the earth was madeThepresent study revealed high number of plant used againstgastrointestinal infection in selected regions of Pakistan thatmight be due to the highest prevalence of these infections instudied regions Various ethnomedicinal studies conductedin studied regions proved the presence of great diversity ofmedicinal plants and occurrence of gastrointestinal infec-tions [14 15 24] Present finding is similar with the studiesconducted elsewhere in other countries [25 26]
42 Plant Families and Growth Form Local healers mostlyused plants that belong to family Apiaceae because this familyhas a unique place in homemade remedies and most of itsplants are traditionally being used against various gastroin-testinal infections not only in Pakistan but throughout theworld [27] that might be due to presence of potential phy-tochemical RosaceaeMalvaceae and Euphorbiaceae are alsoused by the healers afterApiaceae and similar results have alsobeen reported by [28] Present findings are contradictorywithanother ethnomedicinal study conducted somewhere elsein which Asteraceae was found to be most frequently usedplant family against digestive troubles [29] These differencesamong the use of different families among different culturesmight be associated with the dominant native vegetation ofdifferent areas or might be due to different traditional beliefs
BioMed Research International 5Ta
ble1Medicinaluses
ofplantsforstomachtro
ubles
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Abutilonindicum
(L)Sw
eet
Malvaceae
Koso
beta
SA
WWhpl
Decoctio
nor
powderisu
sed
againstcon
stipatio
n1tea
spoo
naft
ermeal
2ndash4teas
poon
saft
ermeal
Lakk
iMarwat
Acaciamodesta
Wall
Mim
osaceae
Phulahi
TP
WBa
Decoctio
nismadeb
ybo
iling
bark
inwater
orpo
wdero
fbark
ismadeb
ygrinding
theb
arkfor
treatmento
fgas
troub
leand
abdo
minaldiseases
2spoo
nsaft
er4h
rsfor1
day
3-4spoo
nsaft
er2h
rsfor2
days
ordepend
son
severity
DIK
han
Acacianilotica(L)Delile
Mim
osaceae
Kikar
TP
WPo
Ba
Decoctio
nof
theb
arkisused
indiarrhea
andpo
dsareg
rindedto
makep
owderm
ixed
with
sugar
orho
neyto
treatdysentery
Smallamou
ntof
powderisg
iven
for1-2
days
500m
ggiven
twicea
dayfor3
days
Kohat
Achyranthesa
speraL
Amaranthaceae
Gho
shkai
HP
WWhpl
Itsdecoctionisused
insto
mach
disorderTh
ejuice
ofthep
lant
isused
inabdo
minalpain
dysenteryandin
bowel
complaints
Depends
ondiseases
everity
Depends
ondiseases
everity
Bann
u
Albizialebbeck
(L)Be
nth
Mim
osaceae
Sirin
TP
CBa
Bark
decoctionisused
totre
atdiarrhea
1-2spoo
n3tim
esad
ay1-2
spoo
naft
er3h
rsfor1
day
Bann
u
Alliu
mcepa
LLiliaceae
Piaz
HA
CBu
Equalamou
ntso
fextractof
onionbu
lbandmintare
mixed
andgivenforc
holera
Halftea
spoo
nof
thismixture
istakenperh
our
fora
perio
das
needed
One
teas
poon
ofthismixture
istakenperh
our
fora
perio
das
needed
DIK
han
Argyrolobium
roseum
(Cam
bess)
Jaub
ampSpach
Nyctaginaceae
Muk
hanBu
tti
SB
WWhpl
Diarrhea
Bann
u
Artemisiaa
bsinthium
LAs
teraceae
Afsanteen
HB
WL
Leaves
areb
oiledto
expel
intestinalwormsindigestion
diarrheaand
vomiting
Asn
eeded
Asn
eeded
Kohat
Asparagusadscend
ensR
oxb
Asparagaceae
Safid
muesli
HA
WR
Groun
droot
iseffectiv
efor
carm
inative
Asn
eeded
Asn
eeded
Karak
Azadira
chta
indica
AJuss
Meliaceae
Neem
TP
CL
Decoctio
nof
leaves
istakenfor
digestivea
ndgastric
prob
lems
2teas
poon
sfor
oned
ay2teas
poon
sfor
oned
ay
DIK
han
Lakk
iMarwat
Bisto
rtaam
plexica
ulis(D
Don
)Greene
Polygonaceae
Masloon
Anjabar
HP
WWhpl
Con
stipatio
nBa
nnu
Kohat
Boerhaavia
diffu
saBrandegee
Nyctaginaceae
Punara
HP
WR
Gas
troub
les
Karak
Camelliasin
ensis
(green
tea)
LKu
ntze
Theaceae
Sabz
pati
HP
CL
Leaves
areb
oiledin
water
mixed
somes
ugar
andtake
orallyfor
indigestionandnausea
1orh
alfcup
once
aday
1cup
aday
DIK
han
Bann
uLakk
iMarwat
6 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Carissa
opacaStapfex
Haines
Apocyn
aceae
Grand
aS
AWC
LR
FDysentery
Karak
Carumcopticu
m(L)Be
nthamp
Hoo
kfex
CB
Clarke
Umbelliferae
Spaerkae
HA
CS
Usedin
sore
throatdiarrhea
dysenteryandvomiting
Kohat
Cassiafi
stula
LCa
esalpiniaceae
Amaltas
TP
CF
Apieceo
fthe
fruitcon
taining
10ndash12seedsa
reslightly
grou
ndandbo
iledin
12liter
ofwater
andstr
ainedford
ysentery
1-2teas
poon
s3tim
esdaily
for1-2
days
3-4teas
poon
s3-4tim
esdaily
DIK
han
Bann
u
Cedrus
deodara(Roxbex
D
Don
)GD
onPinaceae
Diar
TA
CWhpl
Gas
troub
les
Karak
Cinn
amom
umzeylanicu
mBlum
eLauraceae
Dalchini
TP
CBa
Bark
powdera
nddecoctionis
used
ingastrointestinaldisorder
vomiting
dysenteryand
diarrhea
Asn
eeded
Asn
eeded
Kohat
Citru
lluscolocynthis(L)Schrad
Cucurbita
ceae
Kartum
ma
HA
WF
Fruitisc
utboiledin
water
and
sugara
dded
tomakem
urabba
used
forc
onstipatio
nand
abdo
minaldiseases
Asn
eeded
Asn
eeded
DIK
han
Bann
uKo
hat
Lakk
iMarwat
Coria
ndrumsativ
umL
Apiaceae
Dhania
HA
CF
Fruitisc
rushed
andmixed
with
saltas
carm
inativeindigestion
Smallamou
ntof
safoof
2tim
esa
day
Smallamou
ntof
safoof
2tim
esa
day
DIK
han
CrotalariaburhiaBe
nth
Papilio
naceae
Sassai
SP
WWhpl
Drie
dplantisg
roun
dmixed
with
waterand
strainedandis
givenlocally
ford
iarrheaa
ndothera
bdom
inaltro
ubles
DIK
han
Curcum
alonga
LZing
iberaceae
Haldi
HA
CRh
Rhizom
epow
derise
ffectivein
stomachcancerstomach
bleeding
Not
used
still
Asn
eeded
Kohat
Cyperusr
otun
dusL
Cy
peraceae
Delloca
HP
WRh
Rhizom
eise
ffectiveintre
atment
ofdyspepsia
diarrheaa
ndvomiting
Asn
eeded
Asn
eeded
Bann
u
Daturastra
monium
LSolanaceae
Datura
HA
WWhpl
Seedsa
reused
forintestin
alworms
Asn
eeded
Asn
eeded
Karak
Elaeagnu
sangustifoliaL
Cactaceae
Sersang
TP
WR
SF
Con
stipatio
nLakk
iMarwat
Ephedrag
erardian
aWallex
StapfEp
hedraceae
Somane
TA
CW
ShFL
Dyspepsia
Lakk
iMarwat
EquisetumarvenseL
Eq
uisetaceae
Horsta
ilCh
ihly
HP
WWhpl
Diarrhea
Lakk
iMarwat
BioMed Research International 7
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Eugeniajambolana
Lam
Myrtaceae
Jaman
TP
CS
Forstomachprob
lemsgrindthe
seedsa
ndmakep
owder
Asn
eeded
1-2spoo
nsdaily
for3
days
Bann
u
Euphorbiah
irtaL
Euph
orbiaceae
Titra
HP
WWhpl
Stom
achpain
Lakk
iMarwat
FicusreligiosaL
Moraceae
Peepal
TP
WC
BaBu
rntheb
arkandmakep
owder
from
itTake
5gram
sofito
rally
with
water
ford
iarrhea
Asn
eeded
Asn
eeded
Bann
u
Foenicu
lumvulga
reMill
Apiaceae
Saun
fH
AC
F
Equalquantity
offenn
elfruit
coria
nder
fruitAn
ethu
msowa
andsugara
remixed
andgrou
ndtogether
tomakep
owderfor
dyspepsia
andabdo
minalpain
Asrequired
Twicea
dayaft
ermeal
DIK
han
Fumariaindica
(Hausskn
)Pu
gsley
Fumariaceae
Shahtera
HP
WWhpl
Itisused
inachesa
ndpains
diarrheavom
iting
Asn
eeded
Asn
eeded
Kohat
Lyciu
mbarbarum
LSolanaceae
SP
WL
Extractfrom
leaves
iseffectiv
ein
curin
gbloo
dydiarrhea
and
vomiting
Asn
eeded
Asn
eeded
Bann
u
Malva
negle
ctaWallr
Malvaceae
Panerak
HP
WSh
Stom
achpain
Lakk
iMarwat
Malva
parvifloraL
Malvaceae
Puskay
HP
WL
Decoctio
nof
leaves
isused
for
stomachprob
lemItisa
lsoused
aslaxativ
eNot
used
Asneeded
Karak
Meliaa
zadirachtaL
Meliaceae
DharekBa
kain
TP
CW
LF
Leaves
andfruitd
ecoctio
nis
used
toremoveintestin
alworms
Littlea
mou
ntis
given
more
dosage
cause
vomiting
Asn
eededmore
dosage
cause
vomiting
Lakk
iMarwat
Menthalongifolia
(L)L
Lamiaceae
Villanaypo
dina
HA
CWhpl
Freshleaves
areb
oiledin
water
with
greenteam
ixed
somes
ugar
tocure
diarrhea
2teas
poon
safte
r3ho
ursfor
1day
4teas
poon
safte
r3ho
ursfor
1day
Kohat
Lakk
iMarwat
KarakDI
Khan
Nastu
rtium
officin
aleR
Br
Brassic
aceae
Term
era
HP
WWhpl
Leaves
aretaken
orallyfor
constip
ation
Asn
eeded
Asn
eeded
DIK
han
Opuntiadillenii(Ke
rGaw
l)Haw
Cactaceae
Kund
athu
rS
PW
LF
Ripenedfruitisb
oiledin
water
addsomes
ugar
andtake
orally
forc
onstipatio
nAsn
eeded
Asn
eeded
DIK
han
Opu
ntiamonacantha(W
illd)
Haw
Cactaceae
Chnu
tarthar
SP
WWhpl
Digestio
nhelp
DIK
han
Oxalis
cornicu
lata
LOxalid
aceae
Tarookay
HP
WL
Extractjuice
from
fresh
leaves
useo
rally
againststomach
troub
les
Asn
eeded
Asn
eeded
Bann
u
8 BioMed Research International
Table1Con
tinued
Plantand
family
name
Localn
ame
Habit
Life-span
Planto
ccurrence
status
Partused
Usesa
ndrecipes
Dosagea
ndrecovery
Place
Child
ren
Adults
Phyllanthus
emblica
Phyllanthaceae
Amla
TP
WF
Effectiv
eindiarrhea
dysentery
Kohat
Punica
granatum
LPu
nicaceae
Anar
TP
CF
Outer
coverin
gof
fruitisd
ried
andcrushedandpo
wderistaken
with
water
ford
iarrhea
One
tables
poon
daily
for2
-3days
One
tables
poon
daily
for2
-3days
DIK
han
Rosaindica
LRo
saceae
Gulab
SP
CFl
Flow
erarem
ixed
with
sugarp
utin
sunplacetakeo
rally
with
water
andfenn
elforv
omiting
anddyspepsia
2gtwicea
day
5gtwicea
day
DIK
han
Bann
uKo
hat
Saccharumoffi
cinarum
LPo
aceae
Gana
SA
CSt
Stem
extractisu
sefulin
indigestion
Twicea
day
Twicea
day
DIK
han
Lakk
iMarwat
Bann
uSisymbriumirioLinn
Brassic
aceae
Shon
opy
HA
WL
Leaves
areu
sedforstomach
prob
lems
Asn
eeded
Asn
eeded
Karak
Solanu
msuratte
nseB
urmF
Solanaceae
Manragh
onay
HB
WF
Fruitisd
riedcrushedand
powderistaken
fora
bdom
enpain
andgastroub
leAsn
eeded
Asn
eeded
Bann
uKo
hat
Tordylium
nodosum
LAp
iaceae
Hosobeta
HA
WWhpl
Intestinalw
orms
Bann
u
With
ania
coagulan
s(Stocks)
Dun
alSolanaceae
KhapyangaPaneer
HA
WFL
Fruitsarec
rushedm
ixwith
salt
andtake
orallywith
water
for
gastric
andabdo
minalpain
Fruitsares
tained
inwater
and
taken
Extracto
fleavesisu
sed
Twicea
dayfor
2-3days
Thric
eadayfor
3-4days
Karak
KohatD
IKhan
Lakk
iMarwat
Bann
uWoodfordiafru
ticosa(L)Ku
rzLythraceae
Dhawai
SP
WC
FlItisused
indiarrheadysentery
ulcersand
UTI
Kohat
Zizip
husjujub
aMill
Rham
naceae
Jang
libera
TP
WC
F
Roastthe
fruitand
eatfor
the
treatmento
fstomachprob
lems
Take
5gram
sofroo
tpow
dera
nd7pieces
ofblackpepp
ergrin
dandmixused
tocure
diarrhea
andabdo
minalpain
Smallamou
nttwicea
day
400m
gthric
eadayfor3
days
Bann
uD
IKhan
Lakk
iMarwat
Zizip
husn
ummularia
(Burmf)Wight
ampArn
Rham
naceae
Bair
TP
CF
Decoctio
nof
leaves
andbark
isused
indysentery
Asn
eeded
Take
orallythric
ead
ayfor3
-4days
Bann
uD
IKhan
Kohat
Ttre
eSshrubHherbPperenn
ialA
ann
ualB
bienn
ialW
wild
Ccultiv
atedFfruitLleavesFlflo
werW
hPlw
holeplantStstemShshoo
tBa
barkSseedR
roo
tRh
rhizomePo
pod
sandBu
bulb
BioMed Research International 9
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
Table 2 Habit life-span and parts used of medicinal plants
General attributes Total plants ageHabit
Herb 26 50Tree 16 31Shrub 10 19
Life-spanPerennial 32 62Annual 17 33Biennial 3 6
Part UsedFruit 15 24Whole plant 14 23Leaves 12 19Bark 5 8Root 4 6Seeds 3 5Flower shoot and rhizome 2 3Pods stem and bulb 1 2
Growth formWild 35 60Cultivated 23 40
Herb was the dominant growth form used by traditionalhealers for ethnomedicinal preparations and literature reviewalso proved that herbs are the most widely used growth formworldwide [30 31]
43 Traditional Recipes Formulation Traditional healersused all plant parts in remedy preparation but fruit andwholeplant use was most frequent Possible reason behind theseresults might be that whole plant and ripened fruit containhigh concentration of secondary metabolites Present resultsare in line with study conducted in another country in whichfruit is most commonly used part against gastrointestinalproblems [28] while contradictory with other studies inwhich leaves are commonly used against digestive problems[31 32] Often different parts of a single plant may beconcocted and used for a particular type of ailment Forexample the leaves and fruit of Withania coagulans areused to treat gastric problems and abdominal painWithaniacoagulans also ranked first in present study score highestFL value (86) This species could be further subjected tophytochemical and pharmacological investigation for prov-ing its efficacy Decoction was found largest mode of recipepreparation in studied regions and different studies alsoreported that decoction and infusion are the methods mostlyused for the preparation of the folk medicine [15] Traditionalhealers of studied regions used variety of vehicles such assugar salt honey and oil to in herbal formulation and intakeof these preparations in order to minimize the bitter taste ofplants and avoid vomiting
44 Gastrointestinal Infections Treated in the Selected RegionsMost treated diseases in the studied regions are abdominal
pain vomiting nausea and diarrhea because majority ofpeople in the studied regions have little or no access to cleandrinking water which may have increased the occurrence ofwaterborne diseases [33] Gastrointestinal problems are notonly common in the studied areas but are a common issuefor the whole country Moreover such diseases can result inhigher mortality rates if not treated properly on time [34]Fic results have also shown high degree of consensus againstgastrointestinal infections Plants having high informantconsensus against specific ailments are more likely to bebiologically active as compared to plants having less Fic values[35]
45 Diarrhea Morbidity and mortality due to diarrheacontinues to be a major problem in many developingcountries including Pakistan especially amongst childrenWorldwide 78 of children deaths due to diarrhea occur inAfrican and South-East Asian regions [36] Several pathogensare involved in causing diarrhea such as Escherichia coliVibrio cholerae Aeromonas spp Shigella spp Salmonellaspp Pseudomonas spp Klebsiella spp Campylobacter sppand Staphylococcus aureus are most common Present studyexplored 18 medicinal plants species being used traditionallyfor diarrhea in studied regions Bark decoction of Albizialebbeck is traditionally used against diarrhea and literaturereview showed that its extracts had shown moderate activityagainst Vibrio cholerae Aeromonas hydrophila and Bacillussubtilis Ethanolic extract of the stem bark of Albizia lebbeckon castor oil-induced diarrhea has significant activity (119901 lt005) observed at a dose level of 500mgkg [37] Phyto-chemical studies revealed that the crude methanol extractscontained phenolics and flavonoids and these compoundshave previously been reported to possess antimicrobial activ-ities [10] Traditionally seeds of Carum copticum are usedfor the treatment of diarrhea in studied region In vivoactivity ofCarum copticum at a dose of 100mgkg inhibits thegastrointestinal fluid by 3990ndash5070 [38] Fresh tea madeby boiling leaves of Mentha longifolia is considered effectivein curing diarrhea FL results ranked Mentha longifolia onsecond position due to its high citation reports that mightbe due to its higher efficacy and traditional belief of localsIn a castor oil-induced diarrheal model the crude extract ofMentha longifolia at doses of 100ndash1000mgkg provided 31ndash80 protection These data indicate that the antidiarrhealand spasmolytic effects of the crude extract of Menthalongifolia are mediated through the presence of CCB-likeconstituent(s) concentrated in the petroleum spirit fractionand this study provides indirect evidence for its medicinaluse in diarrhoea and spasm [39] Outer covering of Punicagranatum fruit is dried and crushed and powder is takenwithwater for diarrhea in studied regionsMethanolic extractof the fruit was tested in castor-oil and magnesium-sulfateinduced diarrhea in mice at the doses of 200 and 400mgkgbody weight revealed significant antidiarrheal activity (119901 lt0001) and inhibited 3125 defecation at the dose of 200mgkg and 5375 at the dose of 400mgkg in castor oil-induced diarrhea while in magnesium sulfate-induced diar-rhea the inhibition of defecation was 4571 and 5714 at thedoses of 200 and 400mgkg respectively The antidiarrheal
10 BioMed Research International
Table 3 FIC values of traditional medicinal plants for treating stomach problems in study regions
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
Table 4 Fidelity level (FL) values for common medicinal plants used by local traditional healers by ailment category
S number Plant spp Disease category Ip Iu FL1 Rosa indica Vomiting and nausea 12 30 662 Withania coagulans Abdominal pain 31 36 863 Mentha longifolia Diarrhea 30 40 754 Foeniculum vulgare Diarrhea 10 17 585 Phyllanthus emblica Dysentery 5 13 386 Melia azadirachta Intestinal worms 9 12 757 Citrullus colocynthis Constipation 16 22 72
effect of the extract was concentration dependent in bothcastor oil-induced diarrhea and magnesium-sulfate induceddiarrhea Phytochemical screening of the extract revealed thepresence of flavonoids and alkaloids that may play key rolein its antidiarrheal activity [40] Pharmacological evidencesof documented antidiarrheal plants suggest the reliabilityof traditional medicines and also the strong traditionalknowledge of the healers
46 Dysentery Dysentery is a medical condition that mostcommonly occurs in areas where living conditions arecrowded and hygiene is poor Protozoans such as Enta-moeba histolytica and bacteria (Shigella Escherichia coli)are mainly involved in causing dysentery [41] Dysenteryis caused due to ameobiasis (gastrointestinal infection) byEntamoeba histolytica and it affects intestines of about 25of the world population and considered second infectiousdiseases next to malaria [42 43] Antibiotic metronidazole
is used against ameobiasis but reported to produce severalmutagenic effects and in vivo activities showed that it iscarcinogenic to mice and produce several side effects such asnausea vomiting dry mouth metallic taste abdominal painheadache constipation and diarrhea [44] Several studieshave also reported the resistance action of microbes againstmetronidazole [45] Worldwide variety of medicinal plantshave shownmarked inhibitory effects against different proto-zoans such as Entamoeba histolytica andGiardia lambliawithfewer side effects in comparison with allopathic drugs [4446] Present study documented total eight medicinal plantstraditionally being used in treatment of dysentery Reportedplants have not yet been tested in vitro and in vivo againstEntamoeba histolytica infectionThese findings suggest futurestudies on phytochemical and pharmacological aspects ofthese plants against protozoan infections Traditionally fruitofPhyllanthus emblica is effective in treatment of diarrhea anddysentery Methanolic extract of Phyllanthus emblica fruit
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
tested in vitro against Shigella dysenteriae and Escherichiacoli had shown 24mm inhibition at 100mgmL concentra-tion Phytochemical analysis of fruit revealed the presenceof glycosides saponins flavonoids phenols proteins andcarbohydrates [47] Decoction of the bark Acacia niloticais used in diarrhea and pods are grinded to make powdermixed with sugar or honey to treat dysentery Mashram [48]has observed the antimicrobial activity of Acacia niloticaagainst Staphylococcus aureus and Escherichia coli The leafand bark extracts showed zone of inhibition between 16and 155mm respectively and found most active againstEscherichia coli Phytochemical investigation of Acacia nilot-ica showed presence of different secondary metabolites suchas leaf contains apigenin 6-8-bisD-glucoside rutin digestiveprotein crude protein and tannins while bark containstannin terpenoids saponins and glycosides phlobatanningallic acid protocatechuic acid pyrocatechol (+)-catechin(minus) epigallocatechin-57-digallate and so forth [49 50]Thereare very few studies present on in vivo antiprotozoan andantibacterial activities of documented medicinal plants usedagainst dysentery in studied region [51]
47 Constipation Constipation is amedical condition causedby various factors such as excessive intake of antibioticsless fiber and water intake and lack of exercise Clostridium
is considered the common causative agent of constipationin many cases while there is no clear evidence about theinvolvement of other microbes [52] Study reported that 7plants are used for constipation Traditionally fruit of Citrul-lus colocynthis is cut and boiled in water and sugar is added tomakeMurabba used for constipation and abdominal diseasesin all studied regions Ripened fruit Opuntia dillenii is boiledin water with addition of some sugar and taken orally forthe treatment of constipation However literature is almostunavailable on the in vitro and in vivo screening of docu-mented medicinal plants against Clostridium species Studiesshould be carried out on these medicinal plants that couldlead toward some interesting findings and developments
48 Abdominal Pain Abdominal pain is a condition causedby a variety of causes such as constipation indigestion gastricproblem appendicitis menstrual cramps and stomach ulcerHowever traditional people of studied regions use abouttwenty medicinal plants for the treatment of abdominalpain condition Powder of mixture of Foeniculum vulgareCoriandrum sativum and Anethum sowa fruit with sugar isconsidered very effective in reducing abdominal pain andother stomach related complaints The use of mixtures ofplants has recently been recognized to increase the effi-cacy of herbal medicine due to the presence of variety ofsecondary metabolites [53] Withania coagulans fruits arecrushed and mixed with salt and taken orally with waterfor gastric and abdominal pain troubles Study conductedby [54] indicated the presence of alkaloids carbohydratesproteins steroids and sterols anthraquinones flavonoidstannins and saponins Worldwide ethnomedicinal studieshave always provided the basis for the development of newnovel drugs which indicates the reliability and efficacy oftraditional medicines
49 Intestinal Worms Majority of intestinal worms areobligate parasite in humans and grouped under two majorphyla that is Platyhelminthes (flatworms) and Nematoda(roundworms) and they have developed various adaptivestructures to survive in their hosts [55] In studied regionsvery few plants were found to be used traditionally againstthese human intestinal parasites Leaves and fruit decoctionof Melia azadirachta and seeds of Datura strumarium isused to remove intestinal worms Pharmacologically theseplants have also been proved for their in vitro anthelminticactivities [56 57] There are many other plants which arebeing traditionally used against intestinal worms in othercountries and their pharmacological activities have alsobeen proved As an example a study conducted on tenmedicinal plants extracts and their fractions by Ukwubile[55] have shown significant anthelmintic activities amongwhich aqueous extracts showed more prominent activitywith increasing concentration comparable to the standardanthelmintic drug albendazole Issue of parasites resistanceagainst commonly using antibiotics is on rise nowadaystherefore it is urgent need of developing naturally occurringanthelmintics [58]
12 BioMed Research International
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
410 Nausea and Vomiting These are symptoms of othermedical conditions such as stomach infection intestinalblockage food poisoning overeating and appendicitis Intotal eight medicinal plants are being used in studied regionsagainst these symptoms Fic results also showed high con-sensus which indicates the strong agreement of traditionalhealers on using specific plants against these symptomsThese plants should be subjected for further analysis to provetheir efficacy against common conditions related with thesesymptoms
5 Conclusions
Gastrointestinal infections are causing great health loss in theremote regions of Pakistan due to their common occurrenceDue to low income status and lack of modern health facilitiespeople of the region are using medicinal plants for theseinfection They have centuries old traditional knowledge toprepare different types of effective plant remedies againstgastrointestinal disorders Locals of the region are heavilydependent on these medicinal plants therefore causing seri-ous threats to the abundance of these plants There is a direneed to protect thesemedicinal plants before their extinctionProper training should be given to traditional healers forsustainable collection and utilization of this valuable floraFocus should be given to current environmental factorscausing gastrointestinal problems in the region Plants withhigh Fic and FL values should be subjected to further in vitroand in vivo screening that could lead toward the developmentof some novel drugs with fewer side effects Young generationshould be mobilized toward learning these practices beforethe extinction of this knowledge as ethnomedicinal knowl-edge provide a baseline information to chemists pharmacistsand pharmacologists for drug developments
Conflict of Interests
The authors declare that they have no competing interests
Authorsrsquo Contribution
Akash Tariq and Muhammad Adnan designed the researchstudy Akash Tariq Sakina Mussarat and Riaz Ullah con-ducted the field work Akash Tariq and Sakina Mussaratorganized and analyzed the data and wrote the whole paperMuhammad Adnan Abeer Hashem E F Abd Allah andAbdulaziz Abdullah Alqarawi supervised all the stages andprovided comments on the draft All authors have read andapproved the final paper
Acknowledgments
The authors would like to extend their sincere appreciation tothe Deanship of Scientific Research at King Saud Universityfor funding this work through Research Group no RG 1435-014
References
[1] B Sandhya S Thomas W Isabel and R ShenbagarathaildquoEthnomedical plants used by the Valaiyan community ofPiranmalai Hills (reserved forest) Tamilnadu India - A pilotstudyrdquo African Journal of Traditional Complementary andAlternative Medicines vol 3 no 1 pp 101ndash114 2006
[2] G M Hocking ldquoPakistan medicinal plants Irdquo Qualitas Plan-tarum et Materiae Vegetabiles vol 5 no 1-2 pp 145ndash153 1958
[3] M Ibrar F Hussain and A Sultan ldquoEthnobotanical studieson plant resources of Ranyal Hills District Shangla PakistanrdquoPakistan Journal of Botany vol 39 no 2 pp 329ndash337 2007
[4] Z K Shinwari S S Gilani and A Akhlas ldquoSustainable harvestof medicinal plants at bar and Shinaki Valleys Gilgit (NorthernPakistan)rdquo WWF-P Gilgit Consultancy Report 2003
[5] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[6] A B Woods ldquoNurse-midwifery in rural Pakistanrdquo Journal ofNurse-Midwifery vol 36 no 4 pp 249ndash252 1991
[7] Embassy of Pakistan Personal Communication Embassy ofPakistan 1993
[8] A Mahmud F Jalil J Karlberg and B S Lindblad ldquoEarly childhealth in Lahore Pakistan VII Diarrhoeardquo Acta PaediatricaSupplement vol 82 no 390 pp 79ndash85 1993
[9] Y Motarjemi F Kaferstein G Moy and F Quevedo ldquoCon-taminated weaning food a major risk factor for diarrhoeaand associated malnutritionrdquo Bulletin of the World HealthOrganization vol 71 no 1 pp 79ndash92 1993
[10] S Acharyya A Patra and P K Bag ldquoEvaluation of theantimicrobial activity of some medicinal plants against entericbacteria with particular reference to multi-drug resistantVibriocholeraerdquoTropical Journal of Pharmaceutical Research vol 8 no3 pp 231ndash237 2009
[11] P Dharmani P K Mishra R Maurya V S Chauhan andG Palit ldquoAllophylus serratus A plant with potential anti-ulcerogenic activityrdquo Journal of Ethnopharmacology vol 99 no3 pp 361ndash366 2005
[12] Z K Shinwari M Salima R Faisal S Huda and A AsrarldquoBiological screening of indigenous knowledge based plantsused in diarrhealtreatmentrdquo Pakistan Journal of Botany vol 45no 4 pp 1375ndash1382 2013
[13] Y Bibi S Nisa F M Chaudhary and M Zia ldquoAntibacterialactivity of some selected medicinal plants of Pakistanrdquo BMCComplementary and Alternative Medicine vol 11 article 52 pp1ndash7 2011
[14] S Mussarat NM Abdel-Salam A Tariq S MWazir R Ullahand M Adnan ldquoUse of ethnomedicinal plants by the peopleliving around indus riverrdquo Evidence-Based Complementary andAlternativeMedicine vol 2014Article ID 212634 14 pages 2014
[15] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use inthe war affected region of northwest Pakistanrdquo Journal ofEthnobiology and Ethnomedicine vol 10 no 1 article 16 2014
[16] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 pp 1ndash10 2013
[17] A Tariq S Mussarat M Adnan N M AbdElsalam R Ullahand A L Khan ldquoEthnoveterinary study of medicinal plants ina tribal society of sulaiman rangerdquoThe Scientific World Journalvol 2014 Article ID 127526 10 pages 2014
BioMed Research International 13
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
[18] SUllahMRKhanNA Shah S A ShahMMajid andMAFarooq ldquoEthnomedicinal plant use value in the Lakki MarwatDistrict of Pakistanrdquo Journal of Ethnopharmacology vol 158 pp412ndash422 2014
[19] M Giday Z Asfaw Z Woldu and T Teklehaymanot ldquoMedic-inal plant knowledge of the Bench ethnic group of Ethiopiaan ethnobotanical investigationrdquo Journal of Ethnobiology andEthnomedicine vol 5 article 34 2009
[20] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[21] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[22] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986
[23] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hills NY USA 1986
[24] A M Abbasi M A Khan N Khan and M H ShahldquoEthnobotanical survey of medicinally important wild ediblefruits species used by tribal communities of Lesser Himalayas-Pakistanrdquo Journal of Ethnopharmacology vol 148 no 2 pp528ndash536 2013
[25] AMollik T Islam A Khatun D Nasrin R Jahan andM Rah-matullah ldquoMedicinal plants used against gastrointestinal tractdisorders by traditional medicinal practitioners of BangladeshrdquoPlanta Medica vol 75 no 9 p PD57 2009
[26] S D Rout T Panda and N Mishra ldquoEthno-medicinal plantsused to cure different diseases by tribals of mayurbhanj districtof north Orissardquo Studies on Ethno-Medicine vol 3 no 1 pp 27ndash32 2009
[27] N Saini G K Singh and B P Nagori ldquoSpasmolytic potentialof some medicinal plants belonging to family umbelliferaea reviewrdquo International Journal of Research in Ayurveda andPharmacy vol 5 no 1 pp 74ndash83 2014
[28] Y Dogan and I Ugulu ldquoMedicinal plants used for gastroin-testinal disorders in some districts of Izmir province TurkeyrdquoStudies on Ethno-Medicine vol 7 no 3 pp 149ndash161 2013
[29] C M Isabel S Akerreta and R Y Cavero ldquoThe pharmacologi-cal validation of medicinal plants used for digestive problems inNavarra Spainrdquo European Journal of IntegrativeMedicine vol 5no 6 pp 537ndash546 2013
[30] A M Abbasi A M Khan M H Shah M M Shah APervez and M Ahmad ldquoEthnobotanical appraisal and cul-tural values of medicinally important wild edible vegetablesof Lesser Himalayas-Pakistanrdquo Journal of Ethnobiology andEthnomedicine vol 9 no 1 article 66 2013
[31] N Saxena V K Yadav and R K Verma ldquoTraditional knowl-edge of medicinal plants used to cure gastro intestinal problemsin Jalaun district of Uttar Pradesh Indiardquo Journal of MedicinalPlants Studies vol 2 no 4 pp 24ndash28 2014
[32] R Muralidharan and D Narasimhan ldquoEthnomedicinal plantsused against gastrointestinal problem in Gingee Hills of
Villupuram district Tamil Nadurdquo Journal of Applied Pharma-ceutical Science vol 2 no 10 pp 123ndash125 2012
[33] A Azizullah M N K Khattak P Richter and D-P HaderldquoWater pollution in Pakistan and its impact on public healthmdashareviewrdquo Environment International vol 37 no 2 pp 479ndash4972011
[34] A Ribeiro M M Romeiras J Tavares and M T FarialdquoEthnobotanical survey in Canhane village district of massin-gir mozambique medicinal plants and traditional knowledgerdquoJournal of Ethnobiology and Ethnomedicine vol 6 article 332010
[35] T Teklehaymanot and M Giday ldquoEthnobotanical study ofmedicinal plants used by people in Zegie Peninsula Northwest-ern Ethiopiardquo Journal of Ethnobiology and Ethnomedicine vol 3article 12 2007
[36] M Farthing M A Salam G Lindberg et al ldquoAcute diarrheain adults and children a global perspectiverdquo Journal of ClinicalGastroenterology vol 47 no 1 pp 12ndash20 2013
[37] N Balekar D K Jain P Dixit and V Nair ldquoEvaluation ofantidiarrheal activity of ethanolic stem bark extract of Albizzialebbeck Linn in ratsrdquo Songklanakarin Journal of Science andTechnology vol 34 no 3 pp 317ndash322 2012
[38] G Balaji M Chalamaiah B Ramesh and Y A ReddyldquoAntidiarrhoeal activity of ethanol and aqueous extracts ofCarum copticum seeds in experimental ratsrdquo Asian PacificJournal of Tropical Biomedicine vol 2 no 2 pp S1151ndashS11552012
[39] A J Shah N N Bhulani S H Khan N U Rehman andA H Gilani ldquoCalcium channel blocking activity of Menthalongifolia L explains its medicinal use in diarrhoea and gutspasmrdquo Phytotherapy Research vol 24 no 9 pp 1392ndash13972010
[40] SAkter A Sarker andM SHossain ldquoAntidiarrhoeal activity ofrind of Punica granatumrdquo International Current PharmaceuticalJournal vol 2 no 5 pp 101ndash104 2013
[41] W A Petri Jr R Haque and B J Mann ldquoThe bittersweetinterface of parasite and host lectin-carbohydrate interactionsduring human invasion by the parasite Entamoeba histolyticardquoAnnual Review of Microbiology vol 56 pp 39ndash64 2002
[42] S L Stanley Jr ldquoAmoebiasisrdquoThe Lancet vol 361 no 9362 pp1025ndash1034 2003
[43] M Denis and K Chadee ldquoImmunopathology of Entamoebahistolytica infectionsrdquo Parasitology Today vol 4 no 9 pp 247ndash252 1988
[44] D Rani ldquoPlant extracts with antiamoebic properties a theoreti-cal study with reference to entamoeba histolyticardquo InternationalJournal of PharmTech Research vol 3 no 2 pp 1113ndash1117 2011
[45] L A L A Marchat C Gomez D G Perez et al ldquoTwoCCAATenhancer binding protein sites are cis-activator ele-ments of the Entamoeba histolytica EhPgp1 (mdr-like) geneexpressionrdquo Cellular Microbiology vol 4 no 11 pp 725ndash7372002
[46] F Calzada L Yepez-Mulia and A Aguilar ldquoIn vitro suscep-tibility of Entamoeba histolytica and Giardia lamblia to plantsused in Mexican traditional medicine for the treatment ofgastrointestinal disordersrdquo Journal of Ethnopharmacology vol108 no 3 pp 367ndash370 2006
[47] N Singh C Mathur N A Sase S Rai and J Abraham ldquoPhar-maceutical Properties of Emblica officinalis and Phyllanthusemblica extractsrdquo Research Journal of Pharmaceutical Biologicaland Chemical Science vol 6 no 1 pp 1007ndash1016 2015
14 BioMed Research International
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008
[48] N Mashram ldquoAntimicrobial activity of methanol extractsof medicinal plants against bacterial speciesrdquo InternationalResesearch Journal vol 1 no 3-4 pp 147ndash150 2009
[49] G M Wassel S M Abd-El-Wahab E A Aboutabl N MAmmar and M S Afifi ldquoStudy of phenolic constituents andtannins isolated from Acacia nilotica L Willd and Acaciafarnesiana L Willd growing in Egyptrdquo Herba Hungarica vol29 no 1-2 pp 43ndash49 1990
[50] R Chaubal A Tambe S Biswas S Rojatkar V Deshpandeand N Deshpande ldquoIsolation of new straight chain compoundsfrom Acacia niloticardquo Indian Journal of Chemistry B vol 45 no5 pp 1231ndash1233 2006
[51] B Nandagopal S Sankar M Ramamurthy S Sathish andG Sridharan ldquoCould the products of Indian medicinal plantsbe the next alternative for the treatment of infectionsrdquo IndianJournal of Medical Microbiology vol 29 no 2 pp 93ndash101 2011
[52] H Kobayashi K Fujisawa Y Saito et al ldquoA botulism case of a12-year-old girl caused by intestinal colonization of Clostridiumbotulinum type Abrdquo Japanese Journal of Infectious Diseases vol56 no 2 pp 73ndash74 2003
[53] S Zonyane S F van Vuuren and N P Makunga ldquoPharma-cological and phyto-chemical analysis of a medicinal plantmixture that is used as traditionalmedicine inWesternCaperdquo inProceedings of the 38th Annual Conference of the South AfricanAssociation of Botanist p 124 University of Pretoria PretoriaSouth Africa January 2012
[54] C Salwaan S Amrinder A Mittal and S PrabhshimranldquoInvestigation of the pharmacognostical phytochemical andantioxidant studies of plantWithania coagulans dunalrdquo Journalof Pharmacognosy and Phytochemistry vol 1 no 3 pp 32ndash392012
[55] C A Ukwubile ldquoAnti-helminthic properties of some Nigerianmedicinal plants on selected intestinal worms in children (age5ndash13) in Ogurugu South East Nigeriardquo Journal of Bacteriologyamp Parasitology vol 3 no 9 p 159 2012
[56] D Sanjita P Kumar and S P Basu ldquoPhytoconstituents andtherapeutic potential of Datura stramonium Linnrdquo Journal ofDrug Delivery ampTherapeutics vol 2 no 3 pp 4ndash7 2012
[57] V D Szewczuk E RMongelli andA B Pomilio ldquoAntiparasiticactivity of Melia azedarach growing in Argentinardquo MolecularMedicinal Chemistry vol 1 pp 54ndash57 2003
[58] J M Behnke D J Buttle G Stepek A Lowe and I R DuceldquoDeveloping novel anthelmintics from plant cysteine protein-asesrdquo Parasites and Vectors vol 1 no 1 article 29 2008