Medicinal Plants Used as Home Remedies: A Family Survey by First Year Medical Students

Abstract

Background

There is a hierarchical organisation of knowledge in the use of medicinal plants in communities. Medicinal use knowledge starts in the home and is passed on to family members. Next in the hierarchy are neighbours, village elders and finally, traditional healers being the most knowledgeable. For primary health care this hierarchy is actively followed in seeking remedies for ailments.

Materials and Methods

This study was a survey of medicinal plant knowledge from family members of 1^st year medical students registered at Walter Sisulu University. A total of 206 first year medical students participated in this study in 2010 and 2011.

Results

Results revealed 47 species used as home remedies, 32% of which are food plants. Leaves and roots were reported as most commonly used. The top five ailments managed at home were gastrointestinal problems (25 plants), wounds (19 plants), respiratory tract problems (19 plants), infections, including sexually transmitted diseases (19 plants) and pain including headaches (19 plants). Chronic diseases such as hypertension, diabetes, cancer and reproductive ailments also formed a large group of diseases self-managed at home (29 plants).

Conclusion

Family members hold knowledge of medicinal plant use. From this study, first year medical students were made aware of the relationship between common ailments and associated home remedies. This study forms a basis for further study of medicinal plants to validate their use as medicinal remedies.

Introduction

There is a long history of medicinal plant use in most developing countries. The World Health Organisation (WHO) reports that traditional healers constitute the main source of primary health care for at least 80% of rural populations in developing countries (WHO, 2001). Indeed, an estimated 80% of black South Africans, especially those from the more rural parts of the country, use traditional medicines (Jager et al., 1996; Mander, 1998). The Eastern Cape of South Africa is of low socioeconomic standing and predominantly rural and thus highly dependant on traditional methods of health care (Hirst, 1990). The demand for traditional medicines in the Eastern Cape and in other developing countries is evidenced by the huge multimillion rand industry as reported by Cunningham (1989), Dold and Cocks (2002) and Mander (1998). The distribution of traditional medicine knowledge, specifically concerning medicinal plants is hierarchically placed in the community (Yirga, 2010). Knowledge and services are obtained from family members, neighbours, village elders and finally, traditional healers. For primary health care this hierarchy is actively used even before seeking allopathic medicine (Akerele, 1988). To tap into this undocumented knowledge, we sought to use an “ethnobotanical survey in the classroom” approach (De Beer and van Wyk, 2011). The classroom constituted first year medical students registered at Walter Sisulu University. With the unprecedented explosion in the popularity of herbal preparations especially associated with the HIV/AIDS pandemic and chronic illnesses of lifestyle, patients self-medicate with or without informing their physicians (Erasto et al, 2005; Kaschula and Shackleton, 2012; WHO, 2002).

Therefore medical students are an ideal population for this study. As they prepare for their careers, they should be aware of common medicinal plants most likely used by their potential clients. We anticipated that the study will also reveal the common ailments for which home remedies are employed. Previous studies have demonstrated the desire by medical students to learn more about complementary and alternative medicine (CAM) (Greiner et al, 2000) and medical schools are becoming aware of the need to provide CAM-related education (Astin et al, 2006). Indeed, there are schools of thought in support of incorporating traditional medicine into the National Health Care System of South Africa (Pinkoane et al, 2012). Ethnobotanical studies on medicinal plants have been conducted in the Eastern Cape Province of South Africa, specifically for plants used in the treatment of diabetes (Erasto et al., 2005; Oyedemi et al., 2009), HIV/AIDS (Otangi et al, 2012), diarrhoea (Bisi-Johnson et al, 2010), cancer (Koduru et al, 2007) and obesity (Afolayan and Mbaebie, 2010). There is no study reported to determine plants used for self medication. 80% of our students are from the O.R Tambo District Municipality of Mthatha in the Eastern Cape of South Africa (Figure 1). This is a predominantly Xhosa speaking area and it is largely rural. Thus, the medical students involved in this study were representative of the O.R Tambo District Municipality population. This study was an ethnobotanical study of plants used for self medication in homes. The knowledge was obtained from family members of 1st year medical students registered at Walter Sisulu University. The information compiled was shared among classmates in the form of oral presentations and written projects.

Figure 1.

Map showing O.R. Tambo District Municipality. Source: http://www.thinasinako.co.za/files/documents/290806175904.pdf

Method

The study was carried out over a two-year period by first year medical students registered at Walter Sisulu University in 2010 and 2011. Information on folkloric use of plants for management of common ailments was obtained by these students through conversational interviews of family members (Jovel et al, 1996). Students were instructed to obtain information on up to three plants. The information was collected over the April university vacation of both years. The common and scientific names of the plant were reported by the student. Each student was requested to bring a sample of the plant(s) as a “potted” live specimen. Thus where the scientific name was unknown, the plant sample was taken to a botanist for identification and authentication. In addition, botanical names were also searched in literature especially relying on the work of Dold and Cocks (1999) and botanist expert knowledge. Information on the plant part used, what diseases it was used to manage, medication preparation and dosing were also obtained by the student for each plant. Where information was missing for any plant, the result was not reported. A consent form was signed by each of the relatives who participated in this study.

Data Analysis

Data collected was descriptive and therefore information is presented to show plant botanical and local name, part used and preparation for medicament and frequency of reporting by students. Information on a total of 47 plant species and one animal product (hyraceum) are listed in Table 2.

Table 2.

Medicinal plants used for home remedies in the Eastern Cape Province, South Africa.

Plant Species	Local name	Part(s) used and preparation	Uses	No.
Acacia karroo (Fabaceae)	Umnga	Leaves: crush, boil and drink infusion	Headache	2
Agathosma apiculata (Rutaceae)	Ibuchu	Leaves and roots: chew or make an infusion and drink	Abdominal pain, fever, tiredness, chest congestion, urinary infections	5
Alcea rosea (Malvaceae)	Inqwabeba	Leaves: infusion taken orally	respiratory ailments, mental retardation	4
Alepidea amatymbica (Apiaceae)	Iqwili	Rhizome roots: cut into pieces and chewed or decoction or infusion taken orally	flu, asthma, good luck charm, coughs	54
Allium cepa (Lilliaceae)	Onion	Root bulb: cooked whole or decoction taken orally	colds, flu, coughs, cardiovascular conditions, lower cholesterol, prevents tooth decay	16
Allium sativum (Lilliaceae)	Garlic; ivimbampunzi	Root cloves: In food, or take raw orally grated or whole	Hypertension, antibiotic, expectorant, diabetes, heartburn, lower cholesterol	6
Aloe ferox (Aloaceae)	Aloe vera; Ikhala	Leaves - the leaf gel for topical application or crushed leaf in water and taken orally.	sunburns, wounds, nausea, diabetes, acne, obesity, abdominal pain, arthritis, sinus congestion, diarrhea, peptic ulcers	40
Arctostaphylos uva-ursi (Ericaceae)	Bearberry	Stem and leaves: Boil and decoction taken orally	diarrhea, kidney problems	3
Artemisia afra (Asteraceae)	Umhlonyane	Roots, leaves: Decoction taken orally	fever, colds and flu, nasal congestion, coughs, respiratory problems, blood purifier, earaches, asthma, sweaty feet, headaches, sore throat,	51
Aspalatus linearis (Fabaceae)	Rooibos, inkanga	Leaves: boil and drink as tea	insomnia, headaches, nervous tension, hypertension, eczema, stomach cramps, cervical cancer, anti-oxidant, asthma	6
Calendula officinalis (Asteraceae)	Marigold, ibhosisi	Flower: dried and mixed with body creams, infusion taken orally	anti-inflammatory, heals wounds, antiseptic, cleanse blood, stomach cramps, gastric ulcers, blood stained urine,	2
Centella eriantha (Apiaceae)	Iphuzi	Roots: Decoction taken orally or grind and mix with water then apply topically	Sexually transmitted infections (STI's), erectile dysfunction, burning urination, male infertility wound healing	2
Cinnamomum verum (Lauraceae)	True cinnamon	Bark: infusion taken orally or apply topically for bee sting	indigestion, nausea, colds and flu, bee stings	5
Crinum bulbispermum (Amaryllidaceae)	Ibhucu	Bulb: Crush and mix with bath water	pimples and rashes	1
Curcuma langa (Zingiberaceae)	Tumeric	Roots: infusion taken orally or topical application	antiseptic, arthritis, allergies, asthma, cancer, gastric ulcers, acne, to lower cholesterol levels	12
Cynodon dactylon (Poaceae)	Uqaqaqa	Leaves and roots: decoction taken orally or applied topically	sterilise open wounds, anti-inflammatory, nausea	2
Cyrtanthus obliquus (Amaryllidaceae)	Umathunga	Leaves: Topical application or infusion taken orally	wound healing, flu, stomach ache	6
Elephantorrhiza elephantine (Fabaceae or Leguminosae)	Intolwane	Root infusion taken orally	Stomach ache and other gastrointestinal problems
Eucalyptus regnans (Myrtaceae)	Gumtree	Leaves: Add boiling water and breath in the steam or drink hot infusion	Cold and flu, tonsillitis, cough	5
Euclea species (Ebenaceae)	Umtshekesane	Root: decoction taken orally. Stem chewed and used as toothbrush	Respiratory problems, dental hygiene	11
Eugenia caryophyllata (Myrtaceae)	Clove	Flower buds: infusion taken orally	nausea, toothache, indigestion, viral infections, flatulence	4
Helichrysum ordoratissimum (Asteraceae)	Impepho	Leaves, stems: boil and steam in it or burn and inhale the smoke, infusion taken orally	fever, cough, insomnia, stomach ache, toothache, headache	18
Helichrysum pedunculatum/ nudifolium (Asteraceae)	Isicwe	Leaves: boil and drink; prepare paste and apply topically	Used during male circumcision to heal wound, anti-inflammatory, viral infections, treat allergies, remove stretch marks, skin treatments,	50
Hypoxis hemerocallidea (Hypoxidaceae)	African potato, Ilabatheka	Root corm: infusion taken orally, cooked and taken with food, paste applied topically	immune booster in HIV/AIDS infection, blood purification, sunburns, antibiotic, septic sores, headaches, purgative, antioxidant, flu, cancer, acne, diarrhea, urinary tract infections, testicular tumors, arthritis, diabetes, prostate gland enlargement, treat infertility	48
Hyraceum	Umchamo wenfene	Fossilized rock rabbit urine infusion taken orally	Taken in pregnancy to ease pregnancy complications. Diabetes, prostate problems	66
Kniphofia drepanophylla (Aloaceae)	Ixonya	Roots: Decoction taken orally	stomach ache, loss of appetite, gastric worms/parasites	2
Lauridia tetragonia (Celastaceae)	Umdlavuza	Leaves: prepare paste with water and apply topically	healing of wounds and blisters	2
Lavandula spp	Lavender	Leaves: boil to form paste and apply topically on painful area.	headaches, abdominal cramps, dysmenorrhea	3
Lantana rugosa (Verbenaceae)	Utywala bentaka	Leaves infusion taken orally; crushed leaves applied topically	Diabetes, stomach ache, insect repellant	2
Malva parviflora (Malvaceae)	umajikanelanga,	Leaves: infusion taken orally; paste applied topically	Stomach aches, wound healing	2
Mentha longifolia (Lamiaceae)	Inxina	Leaves	Flatulence, stomach ache, wound healing	2
Mentha piperita (Lamiaceae)	peppermint	Leaves and stem: infusion with boiling water taken orally	anti-inflammatory, anti-spasmodic, aromatic, anti-emetic, calm nervousness, antimicrobial, analgesic, stimulant,	3
Nigella sativa (Ranunculaceae)	Black cumin	Leaves and fruit: infusion taken orally	stomach ache, lactogogue, diuretic, antipyretic, diabetes, gastric ulcers, jaundice	2
Ocimum tenuiflorum (Lamiaceae)	Basil	Stem and leaves: fresh crushed or dried - in food or as an infusion taken orally	anti-inflammatory, night blindness, cough, hypertension, migraines	2
Opuntia aurantiaca (Cactaceae)	Itolofiya	Leaves: burn to ashes and mix with petroleum jelly for topical application; Infusion taken orally	Wound and sore healing, diabetes, Hypertension	2
Pentanisia prunelloides (Rubiaceae)	Sicimamlilo	Leaves: grind to form paste and apply on affected area	Healing burns, shingles	2
Portulaca oleracea (Portulacaceae)	Udywangudywangu	Leaves: as an infusion taken orally	increase production of breast milk, stomach aches, relieve blisters and corns on feet, sore throats, mouth sores, TB, diarrhea,	8
Ptaeroxylon obliquum (Rutaceae)	Umthathi	Leaves: chewed and juice swallowed	Toothaches, headaches, Hypertension	4
Punica granatum (Lythraceae)	Pomegranate	Bark, roots, fruit peel, seed: Decoction taken orally or applied topically	diarrhea, hoarseness or loss of voice, stomach ache, hyperactivity, indigestion, poor appetite, nausea, morning sickness, intestinal worms, fever, skin irritation, bleeding piles	3
Rapanea melanophloeos (Myrsinaceae)	Itshongwe; umaphipha	Leaves: infusion/decoction of dried leaves taken orally	diarrhea, stomach ache, headache, anti-emetic, nausea	6
Rumex obtusifolius (Polygonaceae)	Idolo lenkonyane	Leaves and roots - infusion taken orally or topical application	Astringent, blood purifier	1
Solanum aculeastrum (Solanaceae)	Umthuma	Fruit: burn and inhale the smoke through the mouth	relief of toothache	3
Sutherlandia frutescens (Fabaceae)	Umnwele	Leaves and flower petals - Infusion or decoction taken orally	Cancer, inflammation, immune booster in HIV/AIDS infections, antibiotic, stomach ache, fungal infections,	15
Talinum caffrum (Portulacaceae)	Umhlabelo	Root: infusion taken orally	Heal fractured/painful bones, nervousness	1
Teedia lucida (Scrophulariaceae)	uvhete	Root: infusion taken orally	Hypertension, diabetes	3
Tetradenia riparia (Lamiaceae)	Iboza	Leaves: infusion taken orally	stomach ache, diarrhea, coughs, colds, gastric ulcers, respiratory ailments	6
Tulbaghia acutiloba (Alliaceae)	Isivumbampuzi	Roots and leaves: Boil and drink the decoction	stomach ache, cough and fever, chest pain, constipation, cramps, headache, colds and flu, detoxification agent	2
Zingiber officinale (Zingiberaceae)	Ginger; Ujinja	Root: in food or as an infusion taken orally	antibacterial, period pains, muscle cramps, cold and flu, cough	3

Results and Discussion

Table 1 shows a breakdown of first year Medical students who took part in this study. A total of 206 first year medical students participated in this study, 98 in 2010 and 108 in 2011 (Table 1). A total of 164 students (80%) have their homes in the Eastern Cape.

Table 1.

Characteristics of MBChB 1 students involved in medicinal plant survey in 2010 and 2011.

Parameter	2010 group		2011 Group
	Number	%	Number	%
Total	98	100	108	100
Male	44	44.9	53	49.1
Female	54	55.1	55	50.9
Age ≤ 19 yrs	49	54.4	68	63.2
Age >19	41	45.6	40	36.8
Black Africans	83	84.7	95	88
Indian	15	15.3	12	12
Eastern Cape	76	77.6	88	81.5
Other Provinces	22	22.4	20	18.5

The result of the present study revealed a total of 47 plant species and 1 animal product (hyraceum) used by members of families of medical students in the management of common ailments at home (Table 2). A total of 498 plant frequency reports were made. Out of the 47 plant species obtained in the present survey, 15 species (32%) are cultivated and used either for direct consumption as food or sold commercially and some are domesticated. These species included Zingiber officinale, Punica granatum, Opuntia aurantiaca, Ocimum tenuiflorum, Nigella sativa, Mentha piperita, Lavandula spp, Eugenia caryophyllata, Eucalyptus regnans, Curcuma langa, Cinnamomum verum, Calendula officinalis, Aspalatus linearis, Allium sativum and Allium cepa. Since these species are used on a day to day basis, they are therefore easily accessible for household self medications. The use of easily accessible plants for medicinal purposes is also reported in a study in Bangladesh by the Kavijares (Rahmatullah et al, 2010).

The various plant parts used included leaves, stems, roots, barks, flowers and fruits (Table 3). Leaves and roots are most commonly used compared to the other parts. For some species, more than one part is used medicinally. This seems to be a common practice in other cultures too (Giday et al, 2003; Rahmatullah et al, 2010; Wondimu et al, 2007). The majority of plant preparations for oral treatments involve either chewing the plant part to extract the juice or preparation of an aqueous infusion. A few cases report preparation of decoctions which typically involves boiling the plant part (leaf, root, bark) in water. Rarely is a plant dedicated to the treatment of one ailment. In general a single plant is used to treat multiple ailments. Twenty eight (28) plants were used to treat gastro intestinal tract disorders, which included constipation, indigestion, stomach ache an diarrhoea. Nineteen (19) plants were used for treating wounds while eighteen (18) plants each were used for the treatment of respiratory tract problems and infections, especially urinary tract infections and sexually transmitted diseases.

Table 3.

Parts of medicinal plants used to treat various ailments

Part used	Number of species
Leaf	28
Root	20
Stem	3
Flower	3
Fruit	3
Bark	2
Seed	1

This suggests that these first four are the main ailments afflicting communities of reporting medical students. Indeed, it was interesting to note the high number of plants associated with wound healing in a culture that incorporates circumcision as a coming of age ritual. Post-circumcision treatment may account for this high reporting of plants used for wound healing. Other ailments for which home remedies are used include general pain including toothache (11) and headaches (8); chronic illnesses such as diabetes (7), hypertension (5) and cancer (3); reproductive ailments including erectile dysfunction, prostate problems and infertility (6), dysmenorrhoea (5) and lactation problems (3). Thus pain, chronic diseases and “embarrassing” illnesses such as STI's and reproductive ailments seem to be managed at home. In an area with high HIV prevalence, only 2 plants are reported as immune boosters in HIV infection. This may be because treatments in the home are mostly associated with management of AIDS associated opportunistic infections which commonly affect the gastrointestinal and respiratory systems, correlating with the high reporting of these ailments in our study. This study therefore, while primarily revealing plant species used as home remedies, it also highlights the common ailments for which home remedies are used. From this study, first year medical students were made aware of this relationship of common ailments and associated home remedies. It was, indeed, a fundamental lesson for the medical students, early in their careers, that their potential patients will most likely have taken a home remedy prior to presenting themselves to the hospital. Studies have shown that patients first seek medicinal plants before presenting to a primary health care clinic or practitioner. This study also forms a basis for further study of these plants to validate their use as medicinal remedies.

Conclusion

The results of the study revealed that there is rich diversity of medicinal plants used to treat various ailments in the Eastern Cape of South Africa. Families and the local community in the study area possess diverse knowledge of medicinal plants used as home remedies for common ailments. It is interesting to note that domesticated plants are also used as home remedies, thus making the medicaments readily available without fears of sustainable harvesting methods. This study highlights the inherent knowledge in communities concerning medicinal plants - knowledge that is culturally passed down from generation to generation.