An ethnopharmacological survey of natural remedies used by the Chinese community in Mauritius

Abstract

Objective

To collect, preserve and document primary ethnopharmacological information on common natural remedies (NRs) used by the Chinese community to treat and/or manage common diseases in Mauritius, a tropical multicultural island in the Indian Ocean.

Methods

Face-to-face interviews were carried out with 52 key Chinese informants using a semi-structured questionnaire. Quantitative ethnobotanical indices, namely, the informant consensus factor (F_IC), the use value, the fidelity level, the index of agreement on remedies and the relative importance were calculated.

Results

Plants (61) and animal species (17), belonging to 43 and 9 families respectively, constituted the exploited flora and fauna by the Chinese community. Based on the F_IC the main categories of plants used were employed against injury and poisons due to external causes (F_IC=0.97), diseases of the respiratory system (F_IC=0.96), diseases of the eye and adnexa (F_IC=0.95), undefined pains or illness (F_IC=0.95), diseases during the postpartum period, diseases of the digestive system and diseases of the skin and subcutaneous tissue (F_IC=0.94 each). For zootherapy, diseases of the circulatory system, diseases of the eye and adnexa, diseases of the skin and subcutaneous tissue and endocrine, nutritional and metabolic diseases had total consensus (F_IC=1.00).

Conclusions

It was found that the Chinese community of Mauritius still relies, to a great extent, on NRs which need to be preserved and used sustainably. Nonetheless, further research is needed to probe the possible active constituents that could be the basis of an evidence-based investigation to discover new drugs.

1. Introduction

With over 3 000 years of experience, traditional Chinese medicine (TCM) has remained one of the many fascinating areas in ancient Chinese culture. First known to be documented in the Yellow Emperor's Canon of Medicine, TCM is believed to have been practiced in as early as 475 to 221 BC[1]. Indeed, TCM can be considered as one of the oldest healing systems on the planet. It has been argued that TCM can be effectively applied to heal anyone and any health issue no matter what year it is, as it is rooted in unchanging natural law, which has its source beyond time[2]. Although it has fundamentally different approaches from that of conventional medicine (CM), TCM is well integrated in the Chinese health care system as one of the two mainstream medical practices[3]. Presently, millions of patients around the globe make use of TCM. Interestingly, TCM has also been recognised as a popular complementary and alternative medicine in Western countries, emphasising on individualised diagnosis and treatment of patients, maximising the body's self-healing capacity and treatment of the person as a “whole” by addressing their physical, mental, and spiritual attributes[4].

TCM includes panoply of interventions such as herbal remedies, zootherapy, dietary therapy, acupuncture, acupressure and massage (Tui Na), and exercise (Qigong) amongst others. However, it has been reported that plants as well as animals are the most commonly used therapies than any other alternative medicine[5]. Plants and their products are used as tinctures, decoctions; the topical parts or extracts of plants are used to treat and/or manage common ailments such as cold and fever to more serious diseases such as diabetes, hypertension and cardiovascular diseases (CVDs). Moreover, several Chinese herbs have already been transformed into commercial products for treatment of CVDs, such as Compound Danshen Dripping Pills[6]. Diet therapy is also a significant part of TCM as foods can be classified in the same way as herbs and used for medicinal purposes[7]. Acupuncture has been used to heal various diseases and physiologic malfunctions in clinical practice for more than 2 500 years. Due to its efficacy, it has been recommended by the World Health Organisation as an effective complementary and alternative medicine therapy for 43 different disorders[8].

The number of databases and compilations of herbs, herbal formulations, phytochemical constituents and molecular targets is increasing. This continued popularity worldwide suggests that evidence-based research in this field, as well as information regarding the potential efficacy and safety of phytochemical constituents in herbs and TCM formulations, are essential[9], as they serve as extremely useful natural drugs and provide basic compounds for less toxic and more effective drug molecules. Furthermore, the biologically active prototypes can be explored to discover newer and better synthetic drugs or to transform inactive natural products by suitable biological/chemical means into potent drugs.

Mauritius is a multi-cultural country where the Chinese community represents about 3% of the total population[10]. There are around 32 000 Chinese people, who are also called Sino-Mauritians, that come from the Hakka and Cantonese origins predominantly. Most of the Sino-Mauritians live in the capital of the island in a region known as China Town.

Regarding the dearth of updated information on traditional medicine used by the Chinese community from Mauritius, this work has endeavoured to document the primary ethnopharmacological data from the local population concerning natural remedies (NRs) generally used to treat/manage common diseases for the first time.

2. Materials and methods

2.1. Study area

The survey was performed in several regions of Mauritius from 2012-2013 over 9 districts. Different urban and rural areas were visited to interview key informants belonging to the Chinese community.

2.2. Data collection

Direct interviews were conducted among Sino-Mauritians from 2012-2013. The survey was performed using a semi-structured questionnaire. The questionnaire developed was strictly confidential and non-compulsory, and each participant was interviewed alone where appropriate to maintain confidentiality. Participants were given information on the purpose of the survey, and a prior informed consent form was dully signed by the participants before the interview was conducted. During field visits, when a remedy was mentioned by the participant, if possible, the participant was encouraged to show a sample of the remedy which was collected and/or photographed. The collected sample was then identified by local botanists and experts.

The questionnaire comprised of 4 sections (A to D). Demographic data was collected, which included the age, gender, place of residence, level of education, occupation and religious views. Section A of the questionnaire enquired about the use of NRs in general, the source of NRs, motivations behind NRs use, improvement in health status after using NRs, whether their medical doctor is aware that they use NRs and preference of using NRs over conventional medicine. Section B involved questions about the use of herbal/botanical remedies for different diseases and health complications. Information on the plants such as their common local name, parts of the plant used and the methods of preparation and dosage, related complications or side effects and the effectiveness of the herbal/botanical remedies was noted. Section C was designed to document the use of animals and/or animal's parts for different diseases and health complications. Information on the animals such as their common local name, parts of the animal used and the methods of preparation and dosage, related complications or side effects and the effectiveness of zootherapy was noted. Section D was based on other NRs such as mind-body medicine, Reiki, cultural rituals, and acupuncture amongst others.

Some of the interviews were performed during busy hours of common areas such as the traditional ‘bazaars’. Personal visits were also made at homes, herbalists and health centres. During field visits, the characteristics of the NRs were observed and photographed after the interviews. When a remedy was mentioned, the informant was invited to show a sample which was collected, and then the sample was subsequently identified with local botanists and specialists in the field[11],[12]. This documentation will fully recognize the contribution of the local people who have been using the indigenous knowledge, protection of community biodiversity and intellectual property rights, and benefits if any comes out of the study; prior informed consent for publication of the work has been obtained.

2.3. Classification of diseases

For ease of documentation, reported diseases and health complications were classified in 13 categories based on the International Classification of Diseases by the World Health Organisation. The categories were diseases during the postpartum period, diseases of the circulatory system, the digestive system, the ear and mastoid process, the eye and adnexa, the genitourinary system, the musculoskeletal system and connective tissue, the respiratory system, the skin and subcutaneous tissue, endocrine, nutritional and metabolic diseases, infectious and parasitic diseases, injury and poisons from external causes and undefined pains or illnesses.

2.4. Quantitative indexes for medicinal plants and animals

2.4.1. Informant consensus factor (F_IC)

F_IC was used for the general analysis of plants and animals used by the informants. F_IC indicates how homogenous the information obtained, and it is calculated based on the following formula: F_IC=(N_ur-N_t)/(N_ur-1) where, N_ur is the number of individual use reports for a particular illness category, N_t is the total number of species used by all informants for this illness category[13]. F_IC values ranged from 0.00 to 1.00. High F_IC values were obtained when only one or a few species are reported to be used by a high number of respondents to treat a particular health complication. Low F_IC values indicated that informants disagree over which plant to employ for the ailment. High F_IC values can thus be used to highlight particularly interesting species for the search of bioactive compounds.

2.4.2. The fidelity level (FL)

The FL, is the ratio between the number of informants who independently suggested the use of a species for the same major purpose and the total number of informants who mentioned the species for any use, was calculated for the most frequently reported diseases or ailments for the categories with the highest F_IC[14]. It is calculated as follows; FL (%) =Np/N×100 where Np is the number of informants that claimed a use of a species to treat a particular disease, and N is the number of informants that used the plants or animals as a medicine to treat a particular disease.

2.4.3. Use value

The use value shows the relative importance of plants and animals known locally[15]. It is calculated as follows; use value=ΣUi/N, where Ui is the total number of citations per species, and N is the total number of informants.

2.4.4. Index of agreement on remedies

The importance of the individual species was estimated by calculating the index of agreement on remedies (IAR) for each species. IAR was calculated using the following formula: IAR=nr–na/(nr–1) where, nr=the total number of citations registered for the species and na=the number of illness categories that are treated with this species. This value ranges between 0.00 (when the number of illness categories equals to the number of citations) and 1.00 (whereby all the participants agree upon the exclusive use of the species for the particular illness)[16].

2.4.5. Relative importance

Relative importance (RI) is defined by the following formula; RI=NUC+NT where, regardless of the number of informants citing the species, NUC is the number of use-categories of a given species divided by the total number of use-categories of the most versatile species, and NT is the number of types of uses attributed to a given species divided by the total number of types of uses attributed to the most important taxon[15].

2.5. Statistical analysis

All data presented in this study were analysed using Microsoft Excel 2007 and IBM statistical package for social sciences (SPSS) version 16.0. Pearson correlations were also performed to evaluate significant associations and relationships between different variables. P<0.05 was considered as statistically significant.

3. Results

3.1. Demographic profile of respondents

Out of the 52 key informants interviewed, 47 gave their consent to participate in the survey with a response rate of 90.4%. Age, gender, place of residence, highest level of education achieved and religious level of respondents are illustrated in Table 1.

Table 1. Demographic profile of informants.

Indicator	Description	Frequency (%)
Age (y/o)	30-39	9 (19.1)
	40-49	15 (31.9)
	50-59	8 (17.0)
	60-69	6 (12.8)
	70-79	6 (12.8)
	≥80	3 (6.4)
Gender	Male	26 (55.3)
	Female	21 (44.7)
Place of residence	Rural	14 (29.8)
	Urban	33 (70.2)
Highest level of education	None	6 (12.8)
	Primary	28 (59.6)
	Secondary	11 (23.4)
	Tertiary	2 (4.3)
Religious level	Not religious	2 (4.3)
	Quite religious	9 (19.1)
	Religious	11 (23.4)
	Very religious	22 (46.8)
	Extremely religious	3 (6.4)

Significant correlations revealed that age and level of education were closely related to preference for NRs over CM (P<0.05). With increasing age and level of education, the use of NRs over CM was found to increase.

3.2. NRs use

3.2.1. Categories of NRs

As illustrated in Table 2, the use of herbal medicine was the most widely reported (28.5%), followed by meditation (17.0%), Tai Chi (12.7%), zootherapy (12.1%), Reiki (10.9%), massage therapy (7.9%), aromatherapy (6.1%) and acupuncture (4.8%).

Table 2. Categories of NRs used by the Chinese community in Mauritius.

NRs	FOC*	Percentage
Herbal	47	28.5
Meditation	28	17.0
Tai-chi	21	12.7
Zootherapy	20	12.1
Reiki	18	10.9
Massage therapy	13	7.9
Aromatherapy	10	6.1
Acupuncture	8	4.8

*FOC=Frequency of citation.

3.2.2. Ailments for which respondents use herbal/botanical remedies and zootherapy as NRs

Table 3 shows that respondents used herbal/botanical remedies and zootherapy as NRs for a total of 13 different diseases. A total of 20% of the people sought treatment for diseases of the respiratory system, 16% for the digestive system, 13% for the genitourinary system and 13% for undefined pains or illness. The other categories of diseases were less popular among those being treated naturally, with a percentage of only 0.2% for the ear and mastoid process.

Table 3. Ailments for which respondents use herbal/ botanical remedies and zootherapy.

Category	Ailment	FOC	%
Diseases during the postpartum period	Abdominal pain due to blood statis, abnormal uterine bleeding, lactation, miscarriage, postpartum hand and feet swelling	54	3.0
Diseases of the circulatory system	Anemia, angina pectoris, CVDs, hypertension, palpitations	120	6.0
Diseases of the digestive system	Constipation, diarrhea, enteritis, flatulence, gastritis, hemorrhoids, indigestion, ulcers, poor appetite, toothache, vomiting	314	16.0
Diseases of the ear and mastoid process	Ear ache, infections	3	0.2
Diseases of the eye and adnexa	Blurred vision, cataract, eye infections, weak eyesight	96	5.0
Diseases of the genitourinary system	Amenorrhea, chronic cystitis, dysmenorrhea, enlarged prostate gland, impotence, infections, infertility, kidney problems, menopausal syndromes, painful urination, premature ejaculation, premenstrual syndrome, renal incontinence/failure, spermatorrhea, vaginal discharge	242	13.0
Diseases of the musculoskeletal system and connective tissue	Arthritis, muscular pain, rheumatism, swollen muscles, edema	99	5.0
Diseases of the respiratory system	Asthma, colds, cough, nasal congestion, phlegm, pneumonia, sore throat, wheezing	390	20.0
Diseases of the skin and subcutaneous tissue	Acne, boils, eczema, skin eruptions	108	6.0
Endocrine, nutritional and metabolic diseases	Diabetes, jaundice, hepatitis, malnutrition	47	2.0
Infectious and parasitic diseases	Chicken pox, influenza, malaria, measles, ringworm, viral infections	123	6.0
Injury and poisons from external causes	Allergy, burns, cuts and wounds, insect bites, sprains	68	4.0
Undefined pains or illness	Body pain, epiplepsy, excessive sweating, fatigue, fever, headache, insomnia, nervous disorders, spasms and convulsions	244	13.0

FOC=Frequency of citation.

3.2.3. Access to and motivations to use NRs

It was observed that 51% of the participants had access to NRs from the wild, 10.6% of which included their private cultivation of medicinal plants and animals and the remaining (40.4%) from other places. About 36.2% reported that they bought the NRs from the market. The remaining 12.8% obtain NRs after being guided by an herbalist/TCM healer.

During this study, it was found that 78.7% of the Sino-Mauritians interviewed were mostly influenced by family traditions when asked about their motivations to use NRs. A total of 12.8% of the interviewees admitted that they have been guided by friends while the remaining 8.5% were influenced by the media.

Following NR's use, 34.0% of respondents reported that they were completely healed, 59.6% claimed much improvement in their health status and 6.4% reported that their health status improved slightly. It was found that 59.6% of the respondents claimed that their medical doctors were aware that they use NRs whereas 40.4% of them did not inform the latter about it. The majority also preferred to use NRs (68.1%) while 8.5% preferred CM, and 23.4% considered both to be equally effective.

3.3. Zootherapy

Out of the 47 informants, only 20 informants (42.6%) claimed to have used animals as NRs to treat/manage diseases and/or health complications (Table 4).

Table 4. Animal species used by the Chinese community in Mauritius.

Animal/ Scientific name/ Family	Part used	Indication	Preparation and administration	FOC	UV	FL (%)
Ant/ Pachycondyla verenae/ Formicidae	Whole body	Premature graying hair	Fried and eaten	2	0.04	100
Beef/ Bos taurus/ Bovidae	Meat	Cold, chesty cough, lung problems, pulmonary abscess-promotes coughing of thick sputum	Boiled with pumpkin flesh and seeds in soup and added with seasonings	9	0.19	100
Centipede/ Scolopendra morsitans/ Scolopendridae	Whole body (Dried)	Painful headaches, spasms and convulsions, seizures	Decoction. About 1-3 g in water.	3 3	0.13	50 50
Chicken/ Gallus domesticus/ Phasianidae	1. Bones and legs 2. Gizzard	1. Regaining strength when having fever 2. Kidney stones	1. Cooked in soup wiht salt, pepper, garlic, tomatoes and carrots. Consumed twice a day until feeling better 2. Cooked and consumed frequently	6 5	0.23	55 45
Cockroach/ Blatta orientalis/ Blattidae	Whole body (Wingless)	Amenorrhea, postpartum abdominal pain due to blood statis	Killed by boiling in water and left to dry in sun	3 1	0.09	75 25
Deer / Lucanus cervus/ Cervidae	1. Horn 2. Musk (navel gland secretion)	1. Painful headaches 2. Facilitates downward passage of stillborns	1.Fatty substance from horn is wrapped around the head using a cloth 2. Powdered form. Consumed orally	4 4	0.17	50 50
Domestic goat/ Capra aegagrus hircus/ Bovidae	1. Bones Meat 2. Milk	1. Pain in joints and bones due to lack of calcium 2. Similar to breast milk; can be given to feeble, malnourished infants fatigue	1. Cooked in soup with salt, pepper, garlic, tomatoes and vegetables. Consumed frequently 2. Fresh milk consumed	7 2 1	0.17	70 20 10
Frog/ Rana clamitans/ Ranidae	Whole body (Dried) Meat	Wounds, bleeding, rheumatism	Boiled in water and applied with washcloth or cooked and eaten	2 1	0.06	67 33
Leech/ Hirudo medicinalis/ Hirudinea	1. Whole body 2. Secretion	1. Amenorrhea, constipation 2. Inflammation of middle ear	1. Killed by boiling, cut length-wise, dried in the sun, then cooked or ground into powder for oral use 2. Secretion is collected from leech and used topically	2 1 1	0.09	50 25 25
Lizard/ Lacerta sp./ Lacertidae	Secretion	Eye inflammation	Secretion is collected and applied topically	2	0.04	100
Lobster/Metanephrops spp./Nephropidae	Flesh	Measles	Mix cornstarch with the lobster lightly to coat the pieces. Heat up oil in a frying pan, deep fry for 1 min. Add ginger, salt, sugar and pepper	8	0.17	100
Pigeon/ Columba livia/ Columbidae	Whole body	Anaemia	Pigeon is throttled so as not to lose any blood when it is killed. It is then cooked in a soup and consumed frequently	5	0.11	100
Sea horse/ Hippocampus sp./ Syngnathidae	Whole body (Dried)	Arthritis, asthma, impotence, renal failure	Cooked in soup wiht salt, garlic, pepper, tomatoes. Consumed once in 2-3 weeks.	2 1 3 2	0.17	25 13 37 25
Shark/ Carcharhinus amblyrhynchos/ Carcharhinidae	Fin	Renal failure	Cooked in soup with salt, pepper and garlic. Consumed once a week.	3	0.06	100
Snail/ Helix pomatia/ Helicidae	1. Saliva 2. Slime	1. Wounds and injuries 2. Pain associated with rheumatism	Slime and saliva are collected from snail and applied topically	4 2	0.13	67 33
Snake/ Serpentes sp./ Colubridae	1. Meat 2. Skin (Dried)	1. Sore throats, hemorrhoids 2. Skin diseases, acne, boils	1. Cooked in soup with salt, pepper, garlic. 2. Powdered form and applied topically	1 2 2	0.11	20 40 40
White earthworms/ Enchytraeus buchholzi/ Megascolecidae	Whole body	1. High fever, influenza 2. Ear infections	1.Washed then made into a decoction to drink 2. Ground and made into a paste and applied to infected area	1 2	0.06	33 67

FOC=Frequency of citation, UV=use value, FL=Fidelity level

As depicted in Table 4, informants quoted 17 animal species distributed in 9 families, namely, mammals (3), insects (3), birds (2), fish (2), reptiles (2), worms (2), amphibians (1), crustaceans (1) and molluscs (1). Zootherapy was used to treat 13 categories of diseases. Gallus domesticus was the most highly used species with a use value of 0.23 followed by Bos taurus (use value of 0.19) and Lucanus cervus, Capra aegagrus hircus, Metanephrops spp. and Hippocampus sp. each with a use value of 0.17. Scolopendra morsitans and Helix pomatia had a use value of 0.13 each. Columba livia and Serpentes spp had a use value of 0.11 while Blatta orientalis and Hirudo medicinalis each had a use value of 0.09. A use value of 0.06 was recorded for Rana clamitans, Carcharhinus amyblyrhynchos, Pachycondyla verenae, Lacerta spp. and Enchytraeus buchholzi were the least used species with a use value of 0.04 each.

As depicted in Table 5, the most important animal species for different categories of diseases were: Columba livia for the diseases of the circulatory system with a FL of 100%; Lacerta sp. for diseases of the eye and adnexa with a FL of 100%; Carcharhinus amblyrhynchos for diseases of the genitourinary system with a FL of 100%; Bos taurus for diseases of the respiratory system with a FL of 100%; Metanephrops spp. for infectious diseases with a FL of 100%; Pachycondyla verenae for undefined pains or illness with a FL of 100%. Capra aegragus hircus was the most important species for diseases of the muscoskeletal system and connective tissue (FL=70%).

Table 5. Animal species with highest FL values for different categories of diseases.

Category of disease	Most important animal species	FL (%)
Diseases during the postpartum period	Lucanus cervus	50
Diseases of the circulatory system	Columba livia	100
Diseases of the digestive system	Serpents spp.	40
Diseases of the ear and mastoid process	Enchytraeus buchholzi	67
Diseases of the eye and adnexa	Lacerta spp.	100
Diseases of the genitourinary system	Carcharhinus amyblyrhynchos	100
Diseases of the musculoskeletal system and connective tissue	Capra aegagrus hircus	70
Diseases of the respiratory system	Bos Taurus	100
Diseases of the skin and subcutaneous tissue	Serpentes spp.	40
Endocrine, nutritional and metabolic diseases	Capra aegagrus hircus	20
Infectious and parasitic diseases	Metanephrops spp.	100
Injury and poisons from external causes	Helix pomatia	67
Undefined pains or illness	Pachycondyla verenae	100

As shown in Table 6, a total of 13 disease categories were treated by zootherapy. F_IC values for all the different categories of diseases recorded are high, ranging from 0.50 to 1.00.

Table 6. FIC for different categories of diseases (zootherapy).

CA	CB	CC	FIC
Diseases during the postpartum period	2	3	0.50
Diseases of the circulatory system	1	5	1.00
Diseases of the digestive system	2	3	0.50
Diseases of the ear and mastoid process	2	3	0.50
Diseases of the eye and adnexa	1	2	1.00
Diseases of the genitourinary system	7	19	0.67
Diseases of the muscoskeletal system and connective tissue	9	12	0.73
Diseases of the respiratory system	3	11	0.80
Diseases of the skin and subcutaneous tissue	1	2	1.00
Endocrine, nutritional and metabolic diseases	1	2	1.00
Infectious and parasitic diseases	2	9	0.88
Injury and poisons from external causes	3	7	0.67
Undefined pains or illness	7	25	0.75

C^A=Category of disease; C^B=Number of species for the disease category; C^C=Number of citations for the disease category; F_IC= Informant consensus factor= (CC-CB)/(CC-1)

Four categories attained total agreement among respondents (F_IC=1.00), namely, diseases of the circulatory system, diseases of the eye and adnexa, diseases of the skin and subcutaneous tissue and endocrine, nutritional and metabolic diseases. The category for infectious and parasitic diseases (F_IC=0.88) and diseases of the respiratory system (F_IC=0.80) also showed high agreement followed by the undefined pains or illness category (F_IC=0.75) and diseases of the musculoskeletal system and connective tissue (F_IC=0.73). Diseases of the genitourinary system and injury and poisons from external causes were the two categories with an F_IC of 0.67 each. The least agreement among the informants was observed in three categories with an F_IC of 0.50, namely, diseases of the postpartum period, diseases of the digestive system and diseases of the ear and mastoid process.

In relation to views of users on safety of zootherapy, 75% of the zootherapy users agreed that it was safe to use animals to treat ailments, 10% reported that it was a quite safe practice and 15% stated that it was indeed very safe. When the respondents were queried whether they found zootherapy effective as a natural remedy, 65% of the users agreed, 25% strongly agreed and 10% said that they quite agreed.

3.4. Herbal/botanical remedies

As summarized in Table 7, 61 medicinal plants were found to be commonly used by the Chinese community in Mauritius. Primary ethnobotanical information (local/vernacular name(s), parts used, source, number of citations, use value and the dosage) for all the different herbal remedies were collected from the informants and summarized in Table 7.

Table 7. Plant species used by the Chinese community in Mauritius.

Family/ Scientific name	Local/ common name	Indication	Part useda	Preparationb	Administrationc	FOC	UV	IAR	RI	FL (%)
Amaranthaceae/ Celosia cristata	Coquelicot	Hemorrhoidal bleeding	Flo	Dec	Ora	8	0.17	1.00	0.38	100
Amaryllidaceae/ Allium sativum	L'ail Garlic	CVDs, hypertension Cold, flu Arthritis, rheumatism Cuts, insect bites	Bul	Cru	Ora	5 8 6 5	0.51	0.89	2.00	21 33 25 21
Apiaceae/ Coriandrum sativum	Cotomili Coriander	Measles	Who	DB	Loc	11	0.23	1.00	0.38	100
Arialiaceae/ Panax ginseng	Ginseng	1. Improving blood circulation 2. Boosting sexual performance	1. Roo 2. Flo	Inf	Ora	29 15	0.94	0.98	0.75	66 34
Asphodelaceae/ Aloe barbadensis	Aloe vera	1. Blood cleanser Roundworms, ringworms 2. Burns, eczema	Lea	1. Dec 2. Ext	1. Ora 2. Loc	19 3 15	0.79	0.94	1.38	51 8 41
Asteraceae/ Taraxacum officinalis	Pissenlit Dandelion	Increasing lactation in nursing mothers Pulmonary abscess	Her	Dec	Ora	14 3	0.36	0.94	0.75	82 18
Asteraceae / Cirsium segetum	Small thistle	Painful urination Bloody urine	Aer Roo	Inf	Ora	7 6	0.28	1.00	0.50	54 46
Asteraceae/ Artemisia annua	Sweet wormwood	Malaria	Lea	Dec	Ora	8	0.17	1.00	0.38	100
Asteraceae/Artemisia capillaries	Oriental wormwood	Jaundice, hepatitis	Ste Lea	Dec	Ora	8	0.17	1.00	0.50	100
Asteraceae / Ayapana triplinervis	Ayapana	Indigestion Expel worms	Lea	Dec	Ora	16 5	0.45	0.95	0.75	76 24
Asteraceae/ Matricaria chamomilla	Chamomile	Easing cold symptoms Easing headache, insomnia	Flo	Inf	Ora	16 23	0.83	0.97	0.88	41 59
Asteraceae/ Chrysanthemum indicum	Chrysantheme Chrysanthemum	Sore swollen throats, red eyes, can reduce fever, prevent cold and sunstroke, for pneumonia Enteritis	Flo	Inf	Ora	42 5	1.00	0.98	1.50	89 11
Brassicaceae/ Raphanus sativus	Radis Radish	Reducing phlegm, chronic cough with phlegm Indigestion, abdominal pain, acid reflux with belching	See	Dec	Ora	3 11	0.30	0.92	1.13	21 79
Campanulaceae/ Lobelia chinensis	Lobelia	Diuretic Edema	Her (D)*	Dec	Ora	9 8	0.36	0.94	0.75	53 47
Caprifoliaceae/ Lonicera japonica	Chèvrefeuille Honeysuckle	Fever, headache, excessive thirst Viral infections	Flo Her	Inf	Ora	26 21	1.00	0.98	1.00	55 45
Caricaceae/ Carica papaya	Papaya	Pain in joints and muscles Arthritis	Roo	Cru	Loc	8 12	0.43	1.00	0.50	40 60
Caryophyllaceae/ Saponaria officinalis	Saponaire	Skin problems, itches, acne Rheumatism	Who	Dec	Ora	18 9	0.57	0.96	1.00	67 33
Convolvulaceae/ Ipomoea batatas	Patate Sweet potato	Eye problems, poor eyesight, cataract	Roo	Inf	Loc	29	0.62	1.00	0.63	100
Cucurbitaceae/ Cucurbita argyrosperma	Giraumon Pumpkin	1. Expulsion of parasitic worms Increases of lactation in nursing mothers, postpartum hand and feet swelling 2. Pulmonary abscess-coughing of thick sputum	1. See 2. Fle & See	1. Emu 2. Cooked with beef	Ora	13 18 10	0.87	0.95	1.00	32 44 24
Ephedraceae/ Ephedra sinica	Ephedra	Asthma Bronchitis	Ste	Dec	Ora	11 9	0.43	1.00	0.50	55 45
Fabaceae / Myroxylon balsamum	Baume du Perou	Cough	Ext	Cru	Ora	47	1.00	1.00	0.38	100
Fabaceae/ Trigonella foenum-graecum	Fenugrec Fenugreek	Lowering blood sugar level Erectile dysfunction caused by kidney deficiency, lack of libido stomach pain	See	Dec	Ora	3 3 4	0.23	0.78	1.25	30 30 40
Ginkgoaceae/ Ginkgo biloba	Ginkgo	AllergiesPhlegm, wheezingVaginal discharge in yeast infections, urinary tract diseases	LeaNut	Dec	Ora	62312	0.87	0.95	1.38	15 56 29
Hydrangeaceae/ Hydrangea spp.	Hydrangea	Urethritis, cystitis Enlarged prostate gland	Roo	Dec	Ora	18 7	0.53	1.00	0.63	72 28
Lamiaceae/ Mentha x piperita	La menthe Peppermint	Indigestion, colic, bloating	Lea	Raw	Ora	38	0.81	1.00	0.63	100
Lauraceae/ Cassytha filiformis	Liane sans fin	Diarrhea, toothache Cholera, dysentery	Who	Dec	Ora	9 13	0.47	0.95	1.00	41 59
Lauraceae/ Cinnamomum cassia	Cannelle Cinnamon	Anaemia, angina pectoris Cold phlegm, common cold Headaches, fever and chills, sweating	Bar (D)*	Dec	Ora	4 25 15	0.94	0.95	1.63	9 57 34
Linaceae/ Linum usitatissimum	L'orge Grain de lin	1. Laxative 2. To relax the eyes for inflammation	See	1. Dec 2. Pou	1. Ora 2. Loc	18 24	0.89	0.98	0.75	43 57
Longaniaceae/ Strychnos nux-vomica	Nux vomica	Gastrointestinal tract diseases Impotence, menopausal syndromes	See	Dec	Ora	10 6	0.34	0.93	0.88	63 38
Malvaceae/ Hibiscus genevii	Hibiscus	Effective in digestive system Diuretic Inflammation of lymph nodes	Flo	Dec	Ora	12 12 7	0.66	0.93	1.13	39 39 22
Meliaceae/ Melia azedarach	Lilas de Perse Chinaberry	1. Blood cleanser-expel worms 2. Eczema	1. Bar 2. Lea	Dec	1. Ora 2. Loc	28 9	0.79	0.97	0.75	76 24
Meliaceae/ Azadirachta indica	Lilas ‘Neem’	Allergies Chicken pox, measles	Lea	DB	Loc	18 27	0.96	0.98	0.88	40 60
Moraceae/ Morus alba	Mulberry	1. Fever, headaches Dry cough 2. Anaemia, palpitations 3. Blurred vision	1. Bar 2. Fru 3. Lea	Inf Jui	Ora	12 12 7 10	0.87	0.93	1.75	29 29 17 25
Moringaceae/ Moringa oleifera	Brède mouroum	1. Pain in joints and muscles Diabetes 2. Increasing lactation in nursing mothers	1. Dru 2. Lea	Sou	Ora	8 12 11	0.66	0.93	1.13	26 39 35
Myristacaceae/ Myristaca fragrans	Noix de muscade Nutmeg	1. Stops diarrhea, nausea, vomiting, flatulence, poor appetite 2. Rheumatism, sprains, bruises	See	1. Dec 2. Cru	1. Ora 2. Loc	20 8 10	0.81	0.95	1.50	53 21 26
Myrtaceae/ Syzigium aromaticum	Giroffle Clove	Tooth ache, abdominal pain, impotence, vaginal yeast infections	Flo (B)	Raw	Ora	31 13	0.94	0.98	1.00	70 30
Nelumbonaceae/ Nelumbinis nuciferae	Lotus	1. Stabilize kidneys, stops bleeding, enuresis, vaginal discharge, premature ejaculation, spermatorrhea 2. Excessive sweating, fever	1. Sta 2. Lea	Dec	Ora	19 26	0.96	0.98	1.50	42 58
Pedaliaceae/ Sesamum indicum	Sesame	Blurred vision Dizziness	See	Dec	Ora	14 12	0.55	0.96	0.75	54 46
Plantaginaceae/ Plantago asiatica	Plantain	HypertensionInfections, swelling of the prostate gland Painful urination	Her	Dec	Ora	21 13 11	0.96	0.98	1.00	47 29 24
Poaceae/ Cymbopogon citratus	Citronelle	Citronella Cough	Ste Lea	Inf	Ora	47	1.00	1.00	0.38	100
Portulacaceae/ Portulaca oleracea	Pourpier Purslane	1. Hemorrhoidal bleeding Abnormal uterine bleeding 2. Boils, sores, eczema	Lea See	1. Dec 2. Cru	1. Ora 2. Loc	8 11 24	0.91	0.95	1.38	19 26 55
Primulaceae/ Lysimachia Christina	-	Urinary infections	Who	Inf	Ora	7	0.15	1.00	0.38	100
Ranumculaceae/ Rhisoma coptidis	Huang lian	Liver detoxification Malaria	Her	Inf	Ora	7 7	0.30	0.92	0.75	50 50
Rhamnaceae/ Ziziphus zizyphus	Jujube	AnorexiaAsthma in children Hemorrhoids, ulcers Weakness	Fru	Raw	Ora	7 13 9 16	0.96	0.93	1.63	16 29 20 35
Rosaceae/ Prunus mume	Prune Chinese plum	Ulcers	Fru	Raw	Ora	12	0.26	1.00	0.38	100
Rosaceae/ Pruni armaniacae	Apricot	Constipation Eye inflammation	See	Dec	Ora	28 12	0.85	0.97	0.75	70 30
Rosaceae/ Rosa chinensis	Rose	Blood cleanser Amenorrhea, irregular menses, menstrual pain, premenstrual breast tenderness	Flo (B) Flo	Inf	Ora	20 17	0.79	0.97	1.13	54 46
Rosaceae/ Crateagus pinnatifida	Hawthorn	Indigestion	Fru	Jui	Ora	9	0.19	1.00	0.38	100
Rosaceae/ Eriobotrya japonica	Bibasse	Sore throat, common cold	Fru Lea	Raw	Ora	20	0.43	1.00	0.38	100
Rutaceae/ Dictamnus dasycarpus	Dittany	Acute rheumatic arthritis Eczema, rashes, boils Jaundice, eliminate toxins	Roo (Bar) Dec	Ora	Loc	18 18 7	0.91	0.95	1.50	42 42 16
Sapindaceae/ Cardiospermum halicacabum	Poquepoque	Skin problems	Lea	DB	Loc	22	0.47	1.00	0.38	100
Sapindaceae/ Dimocarpus longan	Longane	Insomnia	Fru	Ton	Ora	8	0.17	1.00	0.38	100
Schisandraceae/ Illicium verum	Anis etoile Star anise	Aids digestion Rheumatism	Fru	Dec	Ora	23 5	0.60	0.96	0.75	82 18
Solanaceae/ Lycium barbarum	Goji Wolfberry	Arthritis Diabetes Improves eyesight	Fru	Raw Sou	Ora	7 11 5	0.49	0.91	1.13	30 37 33
Solanaceae/ Capsicum sp.	Piment	Skin problems, lesions, rashes, boils, pimples	Lea	Cru	Loc	8	0.17	1.00	0.88	100
Tiliaceae/ Tilia cordata	Tilleul	Insomnia, nervous disorders, epilepsy, migraines, fatigue	Flo	Inf	Ora	29	0.62	1.00	0.88	100
Verbeneceae/ Verbena officinalis	Verveine	Cough and throat inflammation Helps digestion Insomnia Malaria	Who	Inf	Ora	12 12 17 5	0.98	0.93	1.63	26 26 37 11
Zingebereceae/ Alpinia oxyphylla	Bitter cardamom	Diarrhea Frequent urination due to inflammation	Fru (D)*	Inf	Ora	9 10	0.40	0.94	0.75	47 53
Zingebereceae/ Amomum kravanh	Round cardamom	Diarrhea Nausea, vomiting, morning sickness	Fru (D)* See	Inf	Ora	9 9	0.38	1.00	0.88	50 50
Zingiberaceae/ Zingiber officinalis	Gingembre Ginger	1. Arthritis Nasal congestion, common cold, cough, sore throat 2. Diarrhea, vomiting, nausea	1.Rhi (D)* 2.Rhi (F)*	Inf	Ora	9 29 9	1.00	0.96	1.75	19 62 9
Zingibereceae/ Curcuma sp.	Safran vert	Cough, common cold	Roo	BM	Ora	42	0.89	1.00	0.50	100

^a Part used: Aer, aerial parts; Bar, bark; Bul, bulb; Dru, drumstick; Fle, flesh; Flo, flower; Flo(B), flower bud; Fru, fruit; Her, herb; Lea, leaf; Nut, nuts; Sta, stamen; Ste, stem; See, seeds; Rhi, rhizome; Roo, root; Roo (Bar), root bark; Who, whole plant.

^b Preparation: BM, boiled with milk; Cru, crushed; Dec, decoction; DB, decocted and used to bath; Emu, emulsion; Ext, extract; Inf, infusion; Jui, juice; Raw, raw; Sou, soup; Ton, tonic.

^c Administration: Loc, local; Ora, oral.

*(D): Dried; (F): Fresh. FOC=Frequency of citation. UV=use value.

The highest use value for plant species was 1.00 and the lowest was 0.15. The IAR values for the 61 plant species ranged from 0.78 to 1.00. A total of 22 species had an IAR of 1.00. The two lowest IAR values recorded were 0.89 (Allium sativum) and 0.78 (Trigonella foenum-graecum). The RI of the plant species cited by 47 respondents ranged from 0.38 to 1.75. Out of the 61 plant species recorded, a total of 16 species had RI≤0.50; 26 species had RI from 0.51 to 1.00, 13 species had RI from 1.01 to 1.50, and 6 species with RI from 1.51 to 2.00.

As shown in Table 8, the most important plant species for different categories of diseases were: Celosia cristata, Mentha x piperita, Prunus mume and Crateagus pinnatifidata for diseases of the digestive system each with a FL of 100%; Ipomoea batatas for diseases of the eye and adnexa with a FL of 100%; Lysimachia christina for diseases of the genitourinary system with a FL of 100%; Myroxylon balsamum, Cymbopogon citratus, Eriobotrya japonica and Curcuma spp. for diseases of the respiratory system each with a FL of 100%; Cardiospermum halicacabum and Capsicum spp., for diseases of the skin and subcutaneous tissue each with a FL of 100%; Artemisia capillaris for endocrine, nutritional and metabolic diseases (FL=100%); Coriandrum sativum and Artemisia annua for infectious and parasitic diseases each with a FL of 100%; Dimocarpus longan and Tilia cordata for undefined pains or illness with a FL of 100%; Taraxacum officinalis for diseases of the postpartum period (FL=82%); Panax ginseng for diseases of the circulatory system (FL=66%); Carica papaya for diseases of the musculoskeletal system and connective tissue (FL=60%); Myristica fragrans for injury and poisons from external causes (FL=26%).

Table 8. Plant species with highest FL values for different categories of diseases.

Category of disease	Most important plants	FL %
Diseases during the postpartum period	Taraxacum officinalis	82
	Cucurbita argyrosperma	44
	Moringa oleifera	35
Diseases of the circulatory system	Panax ginseng	66
	Rosa chinensis	54
	Aloe barbadensis	51
	Plantago asiatica	47
Diseases of the digestive system	Celosia cristata	100
	Mentha x piperita	100
	Prunus mume	100
	Crateagus pinnatifidata	100
Diseases of the eye and adnexa	Ipomoea batatas	100
	Linum usitatissimum	57
	Sesamum indicum	54
Diseases of the genitourinary system	Lysimachia Christina	100
	Hydrangea spp.	76
	Cirsium segetum	54
	Lobelia chinensis	53
Diseases of the musculoskeletal system and connective tissue	Carica papaya	60
	Dictamnus dasycarpus	42
Diseases of the respiratory system	Myroxylon balsamum	100
	Cymbopogon citratus	100
	Eriobotrya japonica	100
	Curcuma sp.	100
Diseases of the skin and subcutaneous tissue	Cardiospermum halicacabum	100
	Capsicum sp.	100
	Saponaria officinalis	67
	Portulaca oleracea	55
Endocrine, nutritional and metabolic diseases	Artemisia capillaries	100
	Moringa oleifera	39
	Lycium barbarum	37
Undefined pains or illness	Dimocarpus longan	100
	Tilia cordata	100
	Matricaria chamomilla	59
	Nelumbinis nuciferae	58
	Lonicera japonica	55

As shown in Table 9, a total of 12 disease categories were treated/managed by herbal/botanical remedies. The F_IC results showed that the values for all the different categories of diseases stated by the informants are high, ranging from 0.89 to 0.97. Following F_IC calculations, the category attaining highest agreement among respondents (F_IC=0.97) was injury and poisons due to external causes followed by diseases of the respiratory system (F_IC=0.96), diseases of the eye and adnexa (F_IC=0.95) and undefined pains or illness (F_IC=0.95). Diseases during the postpartum period, diseases of the digestive system and diseases of the skin and subcutaneous tissue also had a high F_IC of 0.94 each, while both the diseases of the circulatory system and diseases of the genitourinary system had an F_IC of 0.93. The high F_IC values of the different categories indicate the agreement among the informants concerning the plants appropriate for the treatment of each particular category.

Table 9. F_IC for different categories of diseases (herbal/botanical remedies).

CA	CB	CC	FIC
Diseases during the postpartum period	4	51	0.94
Diseases of the circulatory system	9	115	0.93
Diseases of the digestive system	21	311	0.94
Diseases of the eye and adnexa	6	94	0.95
Diseases of the genitourinary system	16	223	0.93
Diseases of the musculoskeletal system and connective tissue	8	87	0.92
Diseases of the respiratory system	16	379	0.96
Diseases of the skin and subcutaneous tissue	7	106	0.94
Endocrine, nutritional and metabolic diseases	6	45	0.89
Infectious and parasitic diseases	11	114	0.91
Injury and poisons from external causes	3	61	0.97
Undefined pains or illness	11	219	0.95

C^A=Category of disease.

C^B=Number of species for the disease category.

C^C=Number of citations for the disease category.

F_IC=Informant consensus factor= (C^C-C^B)/ (C^C-1).

The categories of diseases were then analysed in order to determine the most important plants species in each category. Some popular species had 100% FL values, which were: Myroxylon balsamum and Cymbopogon citrates for diseases of the respiratory system, Dimocarpus longan and Tilia cordata for undefined pains or illness, Ipomoea batatas for diseases of the eye and adnexa. The high RI values calculated [Allium sativum (RI=2.00); Morus alba and Zingiberis officinalis (RI=1.75 each); Cinnamomum cassia, Ziziphus zizyphus and Verbena officinalis (RI=1.63 each)] lead us to conclude that that these plants were easily available and affordable by the most of the informants. The high IAR values (1.00) documented for 22 plant species in the present study suggest that all the informants agreed upon the exclusive use of the medicinal plants for a particular disease/health complication.

3.6. Effectiveness of herbal/ botanical remedies

Views of informants on effectiveness of herbal/ botanical remedies were also sought in the present survey. It was found that 55.3% of the users agreed that herbal/botanical remedies were effective, 38.3% strongly agreed and 6.4% reported that they quite agree. None of the informants was found to disagree with the effectiveness of using plants as part of NRs.

4. Discussion

During the last few years, promising advances have been achieved among scientists to explore traditional medicines of Mauritius in an endeavour to evaluate the chemical composition and pharmacological action of various local plant species. While the pharmacological properties of many Chinese herbs have been documented in many countries, there is currently a dearth of information on how TCM are actually used in practice outside China[17]. This study is the first of its kind to document and understand the TCM practices integrated as NRs by the Chinese community of Mauritius, also known as Sino-Mauritians. Mauritius is a developing country where the use of NRs is deeply rooted in all the cultural groups, especially in the Chinese community.

It was found from the present investigation that Sino-Mauritians used various NRs for diseases/health complications and a total of 8 distinct categories of NRs were used to treat/manage 13 different categories of diseases, suggesting that knowledge of TCM among respondents passed on from ancestors to the current generation has been valued and preserved. Moreover, many users of NRs from the Chinese community claimed that the use of NRs was a mean of promoting health, preventing diseases as well as providing effective treatment for their ailments. Herbal/botanical remedies were the most common NRs used by the Sino-Mauritians which tend to show that plants were easily accessed and/or available. Despite the rich floral diversity of Mauritius, some herbalists reported that many of the plants and herbs that they sold to consumers were imported from China. Additionally, they also claimed that many plant species obtained locally have now become less easily acessible.

The use of herbal medicine and zootherapy for the treatment of diseases, meditation for stress, depression and anxiety, and Tai-chi and Reiki were also common in the Sino-Mauritian population. On the other hand, it was found that the use of acupuncture and aromatherapy were the least common practices. This may be attributed to a weak incorporation of these two TCM practices as NRs in Mauritius. Furthermore, the fact that these practices are unpopular can be ascribed to their cost while herbal/botanical remedies are fairly low-priced. This study also showed that the Chinese community had an unwavering stand on the use of natural products for their health complications. Many of the respondents simply relied on nature to find cures for their ailments as they were easily accessible and cheap. It was also observed that the NR users' had their own small-scale private cultivations of medicinal plants and/or animals, in their gardens or yards, with which they had experienced positive health outcomes.

Based on the results of this survey, it was found that gender had no influence on the use of NRs to alleviate diseases amongst the Sino-Mauritian population. Male participants were more responsive during the interviews. This could be due to the fact that the Chinese community is patriarchal and long ago men were more active in handling their families, particularly concerning health issues. This observation is supported by the study carried by Hasan et al[18], which showed that gender does not influence use of NRs. Conversely, other studies demonstrated that more women compared to men reported the use of NRs which was explained by a high interest of a subjective sense of well-being[19],[20].

Some female's informants mentioned that herbalists were very careful about the possible negative effects that some herbs/plants could have on the foetus or expecting mothers, and advised them which species to use during pregnancy. In addition, it was observed that pregnant women preferred to employ TCM that have been used by their ancestors for decades. Some females participants also quoted that they were guaranteed to be cured with the TCM. Such practices were also common for diseases during the postpartum period.

Sino-Mauritians were observed to have profound knowledge on the mode of preparation and administration of herbal remedies. The most suggested methods of preparation of herbals/botanicals were decoctions and infusions, while the most frequent route of administration was oral. This suggests that traditional know-how on the identification of medicinal herbs, its method of preparation and administration was transmitted from generation to generation and this wisdom and awareness has been well preserved by the Chinese community throughout the years.

Interestingly, place of residence of informants was found to have no significant bearing on the use of NRs. Chinese communities from both rural and urban areas were well acquainted to the use of NRs. This may be linked with the fact that similar health facilities are provided in both rural and urban areas by the government. Therefore, the decision of using NRs as an alternative to CM is entirely based upon the users' personal choices and preferences as reported previously[20].

It was reported that the use of NRs by Sino-Mauritians were mostly influenced by family traditions although many claimed that they had started using NRs following advice from friends and peers. Some reported to have been influenced by media such as health magazines and documentaries. Besides, a positive correlation was found between both age and level of education and preference of NRs over CM. This is in line with previous data which showed that as level of education increases, use of alternative medicine also increase[18]. It can also be proposed that respondents who had a preference for NRs over CM found it to be more effective than CM.

Animal-based remedies were found to be an important part of TCM practiced in Mauritius. According to Alves et al., there are varying opinions and documentation on the effectiveness of such remedies[21]–[25]. The categories of diseases with the greatest F_IC values were diseases of the circulatory system, diseases of the skin and subcutaneous layer and endocrine, nutritional and metabolic diseases. Six different animal species scored high FL values which tend to show that most animal species in each category were important. The two most highly used species were Gallus domesticus and Bos taurus. This may be attributed to the easy availability of these two species in Mauritius. None of the informants reported that zootherapy was safe to use and the only reason that other people ignoring to use animals as therapies was due to the dearth of information about it. Given a low exposure, people therefore tend to rely more on CM.

The knowledge and use of herbal/botanical remedies was more popular in the Chinese community in Mauritius as compared to knowledge and use of zootherapy. It was observed that the Sino-Mauritian males of 50 years and above had an impressive awareness of the plants and herbs used in TCM of Mauritius. Data collected from them reflected that traditional knowledge had been cautiously preserved throughout the years. The main reason of not using herbal/botanical remedies was cited as being a lack of knowledge on the subject, which was mostly agreed upon by the users of NRs. They believed that more people would definitely use NRs if they were more aware of its benefits. This is supported by the work of Picking et al., illustrating that lack of knowledge was the main reason cited by non-users of herbal medicine[26].

In the present study, various parts of plants were found to be used for the herbal formulations, with leaves being the most frequently used plant parts. The reason for this is possibly the higher concentration of active agents in this part of the plant. This may arise from the fact that leaves act as reservoirs for photosynthesis or exudates that are thought to contain toxins for plant protection and survival, which consequently be of medicinal values in human health. Interestingly, the work of Nadembega et al. also showed that leaves were used in highest proportion[27]. Most people preferred to use fresh plants for concocting remedies, while others incorporated these into their meals so as to promote good health.

A total of 61 plant species used to treat 13 different categories of diseases were recorded in this study. Based on the importance of species known locally (i.e. use values), Chrysanthemum indicum, Cymbopogon citratus, Lonicera japonica, Myroxylon balsamum and Zingiberis officinalis were found to be the most used species by the infomants. Other important species used by the informants were Verbena officinalis, Azadirachta indica, Nelumbinis nuciferae, Cinnamomum cassia, Panax ginseng and Syzigium aromaticum. All these plant species were well-recognised by people of the Chinese community in Mauritius and use of these species was widespread.

One of the species widely quoted by the informants is Cymbopogon citratus (lemongrass) used against respiratory diseases, and interestingly Bahtiar et al. has recently showed that the solvent fraction possessed good antiviral activity and is used against fever[28]. Also Cymbopogon citratus is a well studied medicinal plant and the essential oil (includes mircene, neral, geranial, and other unidentified compounds) has been documented to be used for fighting colds, dysentery, headaches, and also as a tranquilizer and antispasmodic, besides its antimicrobial activity[29]. Recently, oils of Cymbopogon citratus and Syzygium aromaticum (clove) have been reported to be used in traditional practices of many ancient cultures. In Ayurveda, the traditional system of healing in India, lemongrass oil is used to treat hypertension, fever, stomach disorders, and to reduce pain and inflammation associated with rheumatism, cold and flu, and bacterial and fungal infections of throat, urinary and vaginal tract. Similarly clove oil has been used in treatment of toothache and as a carminative, anaesthetic, and it is also used as an antimicrobial for oral and skin infections. Studies have reported the presence of citral, geraniol and myrcene as major active constituents in lemongrass oil and eugenol predominates in clove oil. These essential oils have been recommended as home remedies for treatment of oral and vaginal fungal infections by numerous publications. Scientific literature has also shown that these oils and its active constituents (citral, geraniol and eugenol) possess antifungal activities[30]. Additionally, the effect of essential oils of Cymbopogon citratus and Syzygium aromaticum has been recently reported to have anti-biofilm activity against strong biofilm forming strains of Candida albicans. Most of the Candida albicans strains tested displayed formation of moderate to strong biofilms and the essential oils of Cymbopogon citratus and Syzygium aromaticum were more active against preformed biofilms compared to amphotericin B and fluconazole[30].

Another plant quoted by informants from the present study is Zingiber officinale which was used mostly against respiratory ailments. Reported data also showed strong anti-candida activity of Zingiber officinale, which may be used for infectious diseases. However, in the present study the plant was solely used for respiratory infections which might be due to the presence of gingerol which has good scavenging activity[31].

Chrysanthemum indicum L. is an important medicinal plant spreading widely in Korea, native of China and Japan, and occasionally grows in Indian gardens for its ornamental multi-colored flowers. It has also been reported to possess inhibitory activity against bacteria and viruses, and it has been used in oriental traditional medicine to treat several infectious. Traditionally, Chrysanthemum indicum has been reported for treatment of pneumonia, colitis, stomatitis, cancer, fever, vertigo, pertussis, hypertensive symptoms, inflammation and parkinson's diseases, and has also been used as antibacterial (oral bacteria) agent[32],[33].

Flowers and buds of Lonicera japonica, commonly known as ‘Jinyinhua’ in Chinese traditional medicines, are used for treatment of affection by exopathogenic wind-heat or epidemic febrile diseases at the early stage, sores, carbuncles, furuncles and swellings. The plant has been reported to possess properties of clearing heat and detoxicating, removing heat from the blood and arresting dysentery. Several pharmacologically active secondary metabolites have been isolated from Lonicera japonica, namely, essential oil, saponins, terpenoids, flavones and phenolics[34].

The present study has endeavoured to collect, preserve and document primary ethnopharmacological information on common NRs used by the Chinese community to treat and/or manage common diseases in Mauritius. It was found that the Chinese community of Mauritius still relies to a great extent on NRs which need to be preserved and used sustainably. Medicinal plants from the tropical island of Mauritius were found to be of particular importance for the Sino-Mauritians as it provides primary health care to them. Among the plant species, Asteraceae is the most used family probably because of the presence of terpenoid essential oils, alkaloids and tannins. However, many of the species recorded lack phytotherapeutic evidence. Further pharmacological evaluations of Chrysanthemum indicum, Cymbopogon citratus, Lonicera japonica and Myroxylon balsamum deserve considerable attention.

Comments

Background

TCM is one of the world's oldest documented medical systems mainly based on herbal and animal medicines. It has spread all over the world and it is recognized as a popular complementary and alternative medicine. Plant secondary metabolites include an array of bioactive constituents which are able to improve human health. The results of ethnobotanical studies can be an important source to start further research to discover new drugs.

Research frontiers

This piece of research can be considered to be of great importance as alternative medicines are gaining much popularity.

Related reports

This is the first report from the island of Mauritius to document alternative medicines used by the Chinese community. The authors have used important and up-to-date quantitative ethnobotanical indices to interpret primary data collected. Also, for ease of documentation, reported diseases and health complications were classified in 13 categories based on the International Classification of Diseases.

Innovations and breakthroughs

This is the first documentation from Mauritius. The pharmacological activity of many plant species used in TCM have been evaluated. Authors have discussed the phytopharmacological properties of important medicinal plants used by the Chinese community.

Applications

The documentation of the uses of alternative and indigenous systems of medicine can provide information on new or scarcely reported properties of medicinal plants, which deserve further pharmacological studies. Results have established baseline data on native remedies used in Mauritius, and it can open avenues for further pharmacological assays.

Peer review

This is a potentially interesting work which have been conducted to collect, preserve and document primary data on common natural remedies used by the Chinese community to treat and/or manage common diseases in Mauritius. Since there has been no previous report on such documentation, this work can provide an opportunity to establish valuable primary information on the different remedies used by the local people and hence open new perspectives for further pharmacological research.