Traditional medicinal knowledge of plants used for cancer treatment by communities of mountainous areas of Fez-Meknes-Morocco

Fatima Ez-Zahra Amrati; Mohammed Bourhia; Meryem Slighoua; Ahmad Mohammad Salamatullah; Abdulhakeem Alzahrani; Riaz Ullah; Amina Bari; Dalila Bousta

doi:10.1016/j.jsps.2021.09.005

. 2021 Sep 20;29(10):1185–1204. doi: 10.1016/j.jsps.2021.09.005

Traditional medicinal knowledge of plants used for cancer treatment by communities of mountainous areas of Fez-Meknes-Morocco

Fatima Ez-Zahra Amrati ^a,^⁎, Mohammed Bourhia ^b,^⁎, Meryem Slighoua ^a, Ahmad Mohammad Salamatullah ^c, Abdulhakeem Alzahrani ^c, Riaz Ullah ^d, Amina Bari ^a, Dalila Bousta ^a

PMCID: PMC8523330 PMID: 34703372

Background

Since their existence on earth, humans have used herbal medicine to meet their requirements for medication. The aim of the study: This work refers to a study conducted to carry out an ethnopharmacological survey of medicinal plants used for the treatment of cancer in Fez-Meknes region of Morocco. Material and Methods: To achieve this goal, 300 informants including 237 local people and 63 herbalists. They were requested to fill a survey related questionnaire aiming at the collection of data about the addressed objective. Informants were asked about the vernacular names, parts of medicinal plants used, mode of preparation, route of administration, reference area as well as the ecological distribution. The Relative Frequency of Citation (RFC) and Fidelity Level (FL) were calculated to identify the most effective plants recommended by informants for disease treatment. Results: The findings obtained in the present survey revealed that 94 species belonging to 47 families have been used for cancer treatment in the region of Fez-Meknes. Fruits, leaves, and seeds are the most commonly used plant parts, by the time powder and infusion arethe most common methods used fordrug preparations. Conclusion: This work may contribute towards the society as it provides interesting data on traditional medicinal knowledge of medicinal plantsused to fight cancer.

Keyword: Ethnopharmacology

1. Introduction

Morocco is a Mediterranean country located in the North of Africa. It’s geologically characterized by the presence of four large mountainous areas named the Rif, the Middle Atlas, the High Atlas, and the Anti-Atlas. Morocco is limited by the Mediterranean sea, the Atlantic Ocean on the north, and the west respectively as well as Sahara in the far south (El-Hilaly et al., 2003).

Morocco is known for its large variety of climatic conditions including both moderate humid and sub-humid climates (Born et al., 2009). The Moroccan flora is one of the richest and varied worldwide with about 4200 species. 22% of which are endemic to Moroccan soil. A large number of medicinal plants have been used by the Moroccan population to fight diseases and most of which got registered in Moroccan pharmacopeia (Rankou et al., 2013); (FENNANE and REJDALI, 2016).

Medicinal plants have widely been used as a natural source of remedies for curing multiple diseases including cancer. According to the World Health Organization (WHO), in developing countries, more than 80 % of people use herbal medicine in the treatment of different diseases (Benali et al., 2017).

Cancer remains one of the most common leading causes of death worldwide despite scientific advances in treatment options (World Health Organization, 2018). For this reason, researchers have a big interest in discovering new natural anticancer agents to mitigate this lethal disease. According to the World Health Organization, cancer was responsible for 9.6 million deaths in 2018. Moreover, about 70% of deaths from cancer occur in developing countries (World Health Organization, 2018).

Due to their accessibility and affordability, natural remedies are widely used in low-income countries to treat cancer (Kabbaj et al., 2012). Anticancer agents based herbal medicines play a crucial role in the daily routines of many urban and rural Moroccans lives. However, ethnopharmacological knowledge of some regions in Morocco, especially in Fez-Meknes region remains poorly known.

This survey aims at identifying the medicinal plants used for cancer treatment by the indigenous population of Fez-Meknes region of Morocco and to contribute towards society as it provides ethnopharmacological knowledge related to cancer treatment in the study area.

2. Materials and methods

2.1. Study area

The study was conducted in four sites within the Fez-Meknes region in Morocco (Fez, Moulay yacoub, Meknes, and Taounate) covering both rural and urban localities (Fig. 1) with the following coordinates; latitude 34 °022003 N□. Geographically, it approximately covers 40.075 Km² making 5.7% of the total land area of the national territory and populated with 4.236.892 people. The climate of the region ranges from the Mediterranean to the continental type, precipitation levels vary between 300 mm/year and 800 mm/a (la Direction Générale des Collectivités Locales, 2015).

Fig. 1 — Map of the study area (Fez- Meknes region- Morocco) with geographic boundaries.

Fez-Meknes region- Morocco is among the most recognized region in the country for use of traditional herbal medicine against diseases and, therefore, was selected for being a study area (Jouad et al., 2001); (Ammor et al., 2020).

2.2. Data collection

An ethnopharmacological survey was conducted from October 2016 until February 2017 in the Fez-Meknes region (Morocco). During this period, 300 informants including 237 local people (sellers, purchasers, consumers, cultivators, workers) and 63 herbalists living in different urban and rural areas were selected to be as informants. Afterward, informants were invited to respond to a face-to-face interview about the vernacular name of plants used to treat cancer, parts of plants used, methods of preparation, route of administration, frequency of use, plant- type of cancer treated, prescription, unique use of traditional medicine or combined of modern. Further questions on criteria of the selected informants including age, gender, education, healthcare choices were addressed in the survey. Afterward, the collected data was analysed and discussed according to the earlier literature.

Patients diagnosed with cancer in the study area, they use herbal medicines as an alternative treatment to fight cancer according to methods reported in the culture and knowledge inherited from previous generations either verbally or written. Based on the medical diagnosis that leads to the identification of cancer type, traditional healers recommend treatment protocols including natural preparations for patients according to the type of cancer diagnosed.

2.3. Data analysis

Data analysis as well as graphs were performed using Excel 10. Ethnobotanical data were calculated using quantitative indices such as the relative frequency of citation (RFC) and fidelity level (FL).

2.3.1. Relative frequency of citation

The relative frequency of citation (RFC) refers to the most commonly cited plants in the study area for use against diseases (Tardío and Pardo de Santayana, 2008). RFC was calculated according to the following formula:

RFC (%) = (FC /N) × 100

FC: Number of informants who use plant species against any disease

N: Total number of informants.

2.3.2. Fidelity level

Fidelity level (FL) was calculated to determine the most frequently used plant species to treat a particular disease.e. cancer in the study area (Friedman et al., 1986). Fidelity level (FL) was calculated according to the following formula:

FL (%) = Np/Ni*100

Np: Number of informants who claim the use of species to treat a particular disease

Ni: Total number of informants who claim the use of plant against any given disease

Plants have high FL values are considered the most preferred and effective species for the treatment of ailment categories (Friedman et al., 1986).

3. Results and discussion

Collected data on medicinal plants used for the treatment of cancer in the Fez- Meknes region was analysed based on the relative frequency of citation (RCF) and fidelity level (FL). RCF and FL values obtained in this work ranged from 0.33 % to 17.67 % and 12.5 % to 89.83 % respectively.

The present survey was carried out in the Fez Meknes region in 4 different locations (Fez, Moulay Yacoub, Meknes, and Taounate) in which it was recorded that 94 plant species belonging to 47 families have been used to fight cancer. These findings were partially in agreement with the earlier data which showed that 63 medicinal plants are traditionally used against cancer (Samouh et al., 2019).

The following medicinal plants were the most reported species in traditional use against cancer in the study area; Apteranthes europaea Guss (17.67 %), Aristolochia longa L. (12 %), Nigella sativa L. (10 %), Allium sativum L. (9.33 %) and Marrubium vulgare L. (7.33 %). On the other hand, our findings were in accordance with the earlier literature which reported that Nigella sativa L. and Aristolochia longa L. have been used for the treatment of cancer in two Moroccan regions; Rabat and Greater Casablanca (Samouh et al., 2019) (Table 1 Table 2).

Table 1.

Medicinal plants used for the treatment of cancer in the region of Fez-Meknes Morocco.

Family Scientific name	Vernacular names	RCF (%)	FL %	Reference area(% of use)	Ecological distribution
Actinidiaceae
Actinidia chinensis var. deliciosa (A.Chev.) A.Chev.	Kiwi	0.67	50	Fez (1) Meknes (1)	Cul
Aloaceae
Aloe vera (L.) Burm.f	Sabar	2.67	57.14	Fez (6) Meknes (2)	Cul
Amaranthaceae
Beta vulgaris L.	Barba	0.33	25	Meknes (1)	Cul
Annonaceae
Annona cherimola Mill.	Chirimoya	1	33.33	Fez (3)	Imp
Apiaceae
Petroselinum crispum (Mill.) Fuss	ma'adnūs	2.67	61.53	Meknes (2) Fez (5) Taounate (1)	Cul
Cuminum cyminum L.	Kemmūn	1	33.33	Fez (3)	Cul
Apium graveolens L.	Krāfes	1	60	Fez (3)	Sp/ Cul
Ammi visnaga (L.) Lam.	bešnīha	0.33	25	Fez (1)	Sp
Foeniculum vulgare Mill.	nāfa'	0.33	20	Taounate (1)	Sp/ Cul
Daucus carota L.	hizzu	1	37.5	Fez (2) Meknes (1)	Cul
Ammodaucus leucotrichus Coss.	kammūn eṣ-ṣōfi	0.33	33.33	Fez (1)	Sp
Pimpinella anisum L.	ḥabbat ḥalāwa	0.33	33.33	Taounate (1)	Cul
Thapsia garganica L.	Deryās	0.33	33.33	Fez (1)	Sp
Magydaris panacifolia (Vahl.) Lange	Frifra	0.33	50	Meknes (1)	Sp
Apocynaceae
Apteranthes europaea (Guss.) Murb.	Daghmos	17.67	89.83	Taounate (3) Fez (40) Meknes (10)	Sp
Arecaceae
Phoenix dactylifera L.	nnhel ’Jmar	0.33	20	Fez (1)	Sp
Aristelochiaceae
Aristolochia longa L.	berezṭom	12	85.71	Fez (31) Meknes (3) Taounate (2)	Sp
Asteraceae
Artemisia herba-alba Asso.	Chih	4	60	Fez (10) Meknes (1) Taounate (1)	Sp
Dittrichia viscosa (L.)	māgrāmān terhalā	1	60	Fez (2) Meknes (1)	Sp
Atractylis gummifera L.	Ddād	0.33	50	Fez (1)	Sp
Chamaemelum nobile (L.) All.	Bābnūj	0.33	14.28	Fez (1)	Cul
Cynara cardunculus L.	horšef	0.33	25	Fez (1)	Cul
Berberidaceae
Berberis hispanica Boiss. & Reut.	Arġīs	3	64.28	Fez (6) Taounate (3)	Sp
Boraginaceae
Borago officinalis L.	lisān aṯ-ṯūr	0.33	25	Fez (1)	Sp
Brassicaceae
Lepidium sativum L.	ḥabb er-ršād	1.33	50	Fez (2) Meknes (1) Taounate (1)	Cul
Brassica oleracea L.	Suflur	0.33	50	Fez (1)	Cul
Brassica rapa L.	Left	0.33	33.33	Fez (1)	Cul
Raphanus raphanistrum subsp. sativus (L.) Domin	Lefjel	0.33	25	Taounate (1)	Cul
Sinapis alba L.	Khardal	1	50	Fez (1)	Sp /Cul
Cactaceae
Opuntia ficus-indica (L.) Mill.	Hendi/zaaloul	1.33	50	Taounate (2) Meknes (2)	Sp/ Cul
Camelliaceae
Camellia sinensis (L.) Kuntze	Atāy	1.67	41.66	Fez (4) Taounate (1)	Imp
Cannabaceae
Cannabis sativa L.	l-kīf	0.33	25	Fez (1)	Cul
Capparidaceae
Capparis spinosa L.	Kabār	2	60	Fez (2) Taounate (3) Meknes (1)	Sp
Caryophyllaceae
Herniaria hirsuta L.	herras leḥjar	0.33	25	Meknes (1)	Sp
Cucurbitaceae
Citrullus lanatus(Thunb.) Matsum. & Nakai	Hadja	0.33	25	Fez (1)	Sp
Cucumis sativus L.	hiyār	0.33	33.33	Fez (1)	Sp
Ephedraceae
Ephedra alata Decne	l-a'lenda	0.67	40	Meknes (1) Fez (1)	Sp
Euphorbiaceae
Euphorbia resinifera O.Berg	zakkūm /tikiūt ddaġmūs	0.33	25	Fez (1)	Sp
Fabaceae
Vicia faba L.	Fūl	0.33	25	Fez (1)	Cul
Cicer arietinum L.	l-ḥommṣ	0.33	25	Fez (1)	Cul
Vicia ervilia (L.) Willd.	Kersenna	0.33	33.33	Fez (1)	Sp + cul
Trigonella foenum-graecum L.	l-ḥelba	4.67	53.84	Fez (12) Meknes(1) Taza(1)	Cul
Glycyrrhiza glabra L.	'arq as-sūs	0.33	16.66	Fez (1)	Sp
Fagaceae
Quercus ilex L.	al-bellūṭ	0.67	28.57	Fez (1) Meknes (1)	Sp
Geraniaceae
Erodium guttatum (Desf.) Willd.	Wadmi	1	13	Fez (1)	Sp
Lamiaceae
Marrubium vulgare L.	merrīwut, merrīwa īfzi	7.33	62.85	Fez (14) Meknes (5) Taounate (2) My Yacoub (1)	Sp
Ajuga iva (L.) Schreb.	Sendgūra	1.33	44.44	Fez (3) Meknes (1)	Sp
Rosmarinus officinalis L.	Azīr	1.33	36.36	Fez (3) Taounate (1)	Sp + Cul
Origanum vulgare L.	Zaatar/Sahtar	1.67	33.33	Fez (3) Taounate (2)	Sp + Cul
Satureja granatensis (Boiss. & Reut.) Sennen & Mauricio	z'ītra	0.33	20	Taounate (1)	Sp
Salvia officinalis L.	Sālmiya	1.67	35.71	Fez (4) My Yacoub (1)	Cul
Origanum majorana L.	Merdedūš	1	33.33	Fez (3)	Cul
Lauraceae
Cinnamomum camphora (L.) J.Presl	Kāfūr	0.33	33.33	Fez (1)	Imp
Liliaceae
Allium sativum L.	ṯūm, ṯūma	9.33	63.63	Fez (19) Meknes (4) Taounate (5)	Cul
Allium cepa L.	l-beṣla hamra	3.33	55.55	Fez (5) Meknes(5)	Cul
Drimia maritima (L.) Stearn	Bsel l 'anṣal	0.67	33.33	Fez (2)	Sp
Allium ampeloprasum L.	Borrō	0.67	13	Fez (1) Meknes (1)	Cul
Linaceae
Linum usitatissimum L.	zerrī'at l-kettān	2	60	Fez (2)	Cul
Malvaceae
Malva sylvestris L.	l-hubbeyza	0.33	33.33	Taounate (1)	Sp
Meliaceae
Rubia cordifolia L.	L'acajou	0.33	20	Meknes (1)	Cul
Mimosaceae
Acacia raddiana Savi	ṭalḥ	0.33	20	Fez (1)	Sp
Vachellia seyal (Delile) P.J.H.Hurter	l-’alk	0.33	25	Fez (1)	Sp
Moraceae
Ficus carica L.	qormīš	1.66	41.66	Fez (2) Taounate (3)	Cul
Myrtaceae
Eugenia caryophyllata Thunb.	qoronfel	0.67	20	Fez (2)	Imp
Oleaceae
Olea europaea L.	Zaytūn	2.67	42.10	Fez (7) Meknes (1)	Sp + Cul
Pedaliaceae
Sesamum indicum L.	Jeljlān	0.67	25	Fez (2)	Cul
Pinaceae
Cedrus atlantica (Endl.) Manetti ex Carrière	l-ārz	0.33	33.33	Taounate (1)	Sp
Pinus halepensis Mill.	Taydā	0.67	66.66	Fez (1)	Sp
Piperaceae
Piper nigrum L.	l-yebzār	0.33	12.5	Fez (1)	Imp
Poaceae
Hordeum vulgare L.	ša’īr	1	50	Fez (1)	Cul
Triticum aestivum L.	l-gemḥ	0.33	25	Fez (1)	Cul
Portulacaceae
Portulaca oleracea L.	Rejla	0.33	50	Taounate (1)	Sp
Punicaceae
Punica granatum L.	er-rummān	1.33	40	Fez (1) Taounate (2) Meknes (1)	Cul
Ranunculaceae
Nigella sativa L.	Sānūj/ Haba Souda/ ḥabbet el baraka	10	71.42	Fez (18) Meknes (4) Taounate (4) My yacoub (4)	Cul
Rhamnaceae
Ziziphus jujube Mill.	Nbak/Sadra	0.33	16.66	Taounate (1)	Sp
Rosaceae
Fragaria × ananassa (Duchesne ex Weston) Duchesne ex Rozier	l-frez	0.33	50	Taounate (1)	Cul
Rutaceae
Citrus aurantium L.	ḥāmmed beldī	1.33	40	Taounate (1) Fez (1)	Cul
Solanaceae
Solanum lycopersicum L.	maṭīša	0.33	33.33	Fez (1)	Cul
Solanum tuberosum L.	bṭāṭa	0.33	50	Fez (1)	Cul
Urticaceae
Urtica dioica L.	Horiga	0.67	40	Fez (2)	Sp
Vitaceae
Vitis vinifera L.	Aanab	1	37.5	Taounate	Cul
Zingiberaceae
Curcuma longa L.	harqum	2.67	57.14	Fez (8)	Imp
Zingiber officinale Roscoe	skenjbīr, skenjabīl	3	56.25	Fez (5) My Yacoub (1) Meknes (1)	Imp
Elettaria cardamomum (L.) Maton	qa’qolla	0.33	33.33	Fez (1)	Imp
Zygophylaceae
Peganum harmala L.	Harmal	1.33	66.66	My Yacoub (3) Fez (1)	Sp

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Sp: Spontaneous; Cul: Cultivated; Imp: Imported.

Informants provided data on plants used for the treatment of cancer in the fez Meknes region including methods of preparation, plant parts used as well as the administration mode. The obtained results are summarized in.

Table 2.

Information about medicinal plants used alone for the treatment of cancer in the region of Fez-Meknes.

Scientific name Family	Parts used	Preparation Modes	Solvant/ Excipient	Administraion route	Cancer type
Actinidiaceae
Actinidia chinensis var. deliciosa (A.Chev.) A.Chev.	F	Raw form Juice	_ Milk	Oral	Colon
Aloaceae
Aloe vera (L.) Burm.f	Ap	Powder Powder mixed with honey Vegetable oil Juice Raw form	Water _ _ Water _	Oral	Leukemia/ Liver
Amaranthaceae
Beta vulgaris L.	F	Raw form	_	Oral	Leukemia
Annonaceae
Annona cherimola Mill.	F	Raw form	_	Oral	Breast
Apiaceae
Petroselinum crispum (Mill.) Fuss	Ap L St + L	Decoction Infusion Infusion	Water Water Water	Oral	Uterus
Cuminum cyminum L.	Sd F	Powder Powder mixed with honey Powder	Water/ Oliveoil/ lemon juice _ Water	Oral	Stomach/ Liver
Apium graveolens L.	L	Infusion	Water	Oral	Leukemia
Ammi visnaga (L.) Lam.	Fl	Decoction	Water	Oral	Colon
Foeniculum vulgare Mill.	Sd	Powder mixed with honey	_	Oral	Colon/ Breast/ Leukaemia
Daucus carota L.	F	Juice	Water	Oral	Leukaemia/ Colon/Lung
Ammodaucus leucotrichus Coss.	L + Fl	Powder	Water	Oral	Lung/ Leukemia
Pimpinella anisum L.	Sd	Powder	Water	Oral	Colon
Thapsia garganica L.	R	Infusion Mixed with honey	Water _	Oral	Breast/ Prostate/ Liver
Magydaris panacifolia (Vahl.) Lange	_	Mixed with honey	_	Oral	Breast
Apocynaceae
Apteranthes europaea (Guss.) Murb.	Ap	Powder Powder mixed with honey Juice	Rancid butter Milk/ Water _ Lemon juice	Oral	Uterus/ Breast/ Lung/ Leukemia
Arecaceae
Phoenix dactylifera L.	F	Raw form	_	Oral	Liver
Aristelochiaceae
Aristolochia longa L.	R	Powder Powder mixed with honey Raw form Decoction/ Infusion	Rancid butter/ Olive oil / Water/ Milk _ _ Water	Oral	Breast/ Uterus/ Colon/ Lung/ Bone/ Prostate/ Ovary/ Stomach
Asteraceae
Artemisia herba-alba Asso.	L ; AP	Decoction/ Infusion Powder mixed with honey	Water _	Oral Poultice/ Oral	Lung
Dittrichia viscosa (L.)	L	Powder mixed with honey Infusion	_ Water	Poultice Oral	Colorectal
Atractylis gummifera L.	R	Incense	_	Inhalation	Lung
Chamaemelum nobile (L.) All.	F	Infusion	Water	Oral	Uterus
Berberidaceae
Berberis hispanica Boiss. & Reut.	R/Ap/St	Powder Powder mixed with honey	Milk _	Oral	Breast
Borraginacees
Borago officinalis L.	AP /Sd	Powder	Water	Oral	Breast
Brassicaceae
Lepidium sativum L.	Sd	Decoction Mixed with honey	Water _	Oral	Lung/ Bone/Uterus
Brassica oleracea L.	Ap	Raw form	_	Oral	Breast
Raphanus raphanistrum subsp. sativus (L.) Domin	F	Raw forme	_	Oral	Leukemia
Sinapis alba L.	F	Powder	_	Oral	Colon
Cactaceae
Opuntia ficus-indica (L.) Mill.	F C	Raw form Raw form Juice	_ _ Water	Oral	Bone/ Prostate
Camelliaceae
Camellia sinensis (L.) Kuntze	L	Decotion/Infusion	Water (Sugar free)	Oral	Breast/ Bone
Cannabaceae
Cannabis sativa L.	Sd	Powder mixed with honey	_	Oral	Brain
Capparidaceae
Capparis spinosa L.	F L	Powder Powder mixed with honey	Vegetable oil/ Water _	Oral	Breast/Uterus
Caryophyllaceae
Herniaria hirsuta L.	Ap	Powder	Water	Oral	Leukemia
Cucurbitaceae
Citrullus lanatus(Thunb.) Matsum. &Nakai	F	Juice	Water	Oral	Breast/ Leukemia
Cucumis sativus L.	F	Raw form	_	Oral	Leukemia
Ephedraceae
Ephedra alata Decne	Ap	Decoction	Water	Oral	Breast
Euphorbiaceae
Euphorbia resinifera O.Berg	Ap/R	Powder mixed with honey Decoction + Maceration with Cicer arietinum	_ Water/water	Oral Oral	Breast/ Lung/ Uterus/ Leukemia
Fabaceae
Vicia faba L.	Sd	Powder mixed with honey	_	Oral	Breast
Cicer arietinum L.	F	Raw form	Water	Oral	Leukemia
Vicia ervilia (L.) Willd.	Sd	Powder	Milk	Oral	Breast
Trigonella foenum-graecum L.	Sd	Raw form Powder infusion Powder mixed with honey	Water Water _	Oral Oral	Colon/ Breast/ Uterus/ Colon/ Lung/ Leukemia/ Stomach
Glycyrrhiza glabra L.	Ap	Powder mixed with honey	_	Oral	Breast/ Colon
Fagaceae
Quercus ilex L.	F	Juice Steamed	Milk	Oral	Leukemia
Geraniaceae
Erodium guttatum (Desf.) Willd.	R	Powder Powder mixed with honey	Milk	Oral	Bone
Lamiaceae
Marrubium vulgare L.	Ap	Decoction/infusion Powder Powder mixed with honey	Water Water _	Oral	Colon/ Breast/ Uterus/ Leukaemia/ Stomach
Ajuga iva (L.) Schreb.	Fl L	Powder mixed with honey Powder	_ Water	Oral	Breast
Rosmarinus officinalis L.	L	Decoction/infusion	Water	Oral	Colon/ Breast/ Uterus/ Stomach
Origanum vulgare L.	Ap	Infusion	Water	Oral	Stomach
Satureja granatensis (Boiss. & Reut.) Sennen & Mauricio	Ap	Infusion	Water	Oral	Lung
Salvia officinalis L.	L	Infusion Powder	Water Water	Oral	Lung/ Prostate
Origanum majorana L.	L	Powder Infusion	Water Water	Oral	Breast
Lauraceae
Cinnamomum camphora (L.) J.Presl		Powder	_	Oral	Uterus
Liliaceae
Allium sativum L.	B	Cooked with chicken Juice Maceration Raw form mixed with honey	Olive oil Olive oil _	Oral	Breast/ Uterus/ Colon/ leukemia / Prostate
Allium cepa L.	B	Cooked with chicken Juice	_ Water	Oral	Leukemia/ Breast/ Uterus/ Colon/ Lung/ Prostate/ Ovary
Drimia maritima (L.) Stearn	R	Maceration Infusion	Apple cider vinegar Water	Oral	Lung
Allium ampeloprasum L.	_	Infusion	Water	Oral	Breast
Linaceae
Linum usitatissimum L.	Sd	Powder Powder/ Raw form mixed with honey Raw form	Olive oil /Water _ Water	Oral	Breast/ Prostate/ Colon/ Leukemia/ Ovary
Malvaceae
Malva sylvestris L.	Ap	cooked (dish)	_	Oral	Leukemia/ Breast
Meliaceae
Rubia cordifolia L.	N	Raw form	_	Oral	Leukemia
Mimosaceae
Acacia raddiana Savi	Rs	Infusion	Water		Leukemia
Vachellia seyal (Delile) P.J.H.Hurter	Rs	Infusion	Water	Oral	Leukemia
Moraceae
Ficus carica L.	F	Powder mixed with honey Maceration (One week)	_ Olive oil	Oral	Lung/ Prostate/ Breast/ Uterus
Myrtaceae
Eugenia caryophyllata Thunb.	Sd	Powder	Water	Oral	Stomach
Oleaceae
Olea europaea L.	F L	vegetable oil Decoction	_ Water	Oral	Breast/ Colon/ Stomach/ Leukemia/ Uterus/ Lung/
Pedaliaceae
Sesamum indicum L.	Sd	Powder mixed with honey	_	Oral	Lung/ Pancreatic
Pinaceae
Cedrus atlantica (Endl.) Manetti ex Carrière	F	Powder mixed with honey	_	Oral	Lung
Pinus halepensis Mill.	St + L	Decoction/Infusion	Water	Oral	Lung
Piperaceae
Piper nigrum L.	Sd	Powder (spice)	_	Oral	Breast/Colon
Poaceae
Hordeum vulgare L.	Sd	Powder (Soup ; Bread) Infusion	Water + Milk Water	Oral	Colon
Triticum aestivum L.	Sd	Powder (Bread) Infusion	Water	Oral	Colon/ Stomach
Portulacaceae
Portulaca oleracea L.	Ap	cooked (dish)	_	Oral	Stomach
Punicaceae
Punica granatum L.	E M	Decoction/Infusion Raw form	Water _	Oral	Breast
Ranunculaceae
Nigella sativa L.	Sd	Powder Powder mixed with honey Infusion	Milk _ Water	Oral	Colon/ Breast/ Leukemia/ Uterus/ Lung
Rhamnaceae
Ziziphus jujube Mill.	F	Powder mixed with honey	_	Oral	Breast
Rosaceae
Fragaria × ananassa (Duchesne ex Weston) Duchesne ex Rozier	F	Raw form	_	Oral	Breast
Rutaceae
Citrus aurantium L.	F	Juice	_	Oral	Breast/ Colon/ Lung
Solanaceae
Solanum lycopersicum L.	F	Raw form	_	Oral	Prostate
Solanum tuberosum L.	_	Juice	Water	Oral	Breast
Urticaceae
Urtica dioica L.	L	Infusion	Water	Oral	Leukemia
Vitaceae
Vitis vinifera L.	F	Raw form	_	Oral	Breast/ Uterus/ Leukemia
Zingiberaceae
Curcuma longa L.	R St	Powder Decoction/ Mixed with honey	tea/Milk/Water/ Spice Water/ Lemon juice	Oral	Breast/ Leukemia/ Uterus/ Colon/ Stomach/ Lung/ Bone
Zingiber officinale Roscoe	Ap R	Decoction Raw form Powder mixed with honey	Water Water _	Oral	Breast/Colon/ Prostate/ Uterus
Elettaria cardamomum (L.) Maton	Sd	Powder	Orange juice	Oral	Breast
Zygophylaceae
Peganum harmala L.	Sd/St	Powder/ mixed with honey	Pomegra nate juice / Apple juice	Oral	Lung / Breast

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Ap : Aerial part ; B : Bulb; C : Cladode; E : Exocarp ; F : fruits; Fl : Flowers; L : Leaves;

M : Mesocarp ; N : Nut; Rs: Resin; R : Roots ; Sd : Seeds ; Sh : Shoot ; St : Stem ; T : Tubers ; Wp : Whole plant.

Fidelity level parameter permits the identification of the most abundant species used to treat cancer in the study area. Among 94 inventoried plants 14 species were identified with FL equal or greater than 60%.

In the current research study, it was reported that Apteranthes europaea Guss. (89.83 %), Aristolochia longa L. (85.71 %), Nigella sativa L. (71.42 %), Peganum harmala L. (66.66 %), Pinus halepensis Mill. (66.66 %), Berberis hispanica Boiss. & Reut. (64.28 %), Allium sativum L. (63.63 %) and Marrubium vulgare L. (62.85 %) were the most common medicinal plants used for cancer treatment in the Fez-Meknes region. Our study agrees with the earlier literature which showed that plants higher in FL values are recommended for cancer treatment (Tadesse et al., 2018).

The use of medicinal plants is more among women rather than men (67% vs. 33%) according to our survey (Fig. 2c). Women are more knowledgeable about the uses of medicinal plants. Apart from this, women of the region studied also impart knowledge to their wards either verbally or written. These results were in accordance with the earlier data (Samouh et al., 2019). In the current survey, it was reported that several informants were illiterate (Fig. 2.a). This finding was in agreement with other ethnobotanical studies (Kabbaj et al., 2012);(Ammor et al., 2020) . 69% of respondents prefer the use of modern medicine against cancer vs. 27 % prefer the use of herbal medicine. However, only 4 % of informants prefer the combination of both (Fig. 2.b). Reasons that make many people based in the study area using herbal medicines for medication against cancer have already been reported in the previous literature (Bourhia et al., 2019). The latter reported the effectiveness of traditional preparations in the treatment of cancer, less side effects compared to conventional drugs, inaccessibility to modern medicines for those living in rural areas, the high and rising cost of medical care for people with low income. However, many informants (69 %) as reported in our survey are no longer interested in using traditional medicine for medication against cancer. This result can be explained by the fact that several informants are aware of side effects of the uncontrolled use of plants in the treatment, potential toxicities of plants, lack of scientific validity for plants randomly used in the treatment (González-Tejero et al., 2008).

« a »: Educational Level; « b »: Healthcare choices; « c »: Gender of informants

In the present research work, we found that the the mostely used plants for the treatment of cancer in the region are prepared into powder form 35 %, infusion 20 %, raw form 15 %, decoction 11 %, juice 6 %, maceration and cooking 3 %, vegetable oil 2 % and incense 1 % (Fig. 3). 95 % of remedies are taken orally (Fig. 4). Fruits are the mostely used plant parts with a percentage of 23.53 %, followed by leaves 18, 63 %, aerial parts, and seeds 15.69 % in each, roots 8.82 %, stems 5.88 %, flowers 3.92 %. However, Bulb, resin, cladode, mesocarp, exocarp, and nut are rarely used (Fig. 5).

Fig. 5 — Percentage of plant parts used for cancer treatment in the study area.

F : fruits; L : Leaves; Ap : Aerial part ; Sd : Seeds; R : Roots ; St : Stem; Fl : Flowers; B : Bulb; Rs: Resin; C : Cladode; M : Mesocarp; E : Exocarp; N : Nut.

The most useful plant families for the treatment of cancer in the Fez-Meknes region are Apiaceae (10 species), followed by Lamiaceae (7 species), Asteraceae, Brassicaceae, Fabaceae (5 species in each), and Liliaceae (4 species) (Fig. 6). This ethnobotanical survey disagrees with another survey conducted in the Greater Casablanca region which reported that Aristolochiaceae is the most common plant families used in the traditional treatment of cancer (Bourhia et al., 2019).

Fig. 6 — Number of plant species per family.

The results of the present survey showed that 31.67 % of respondents were aged between 21 and 30 years, 23.33 % between 31 and 40 years, 17.33 % between 41 and 50 years, and 15.33 % between 51 and 60 years (Table 3). These results are in accordance with the earlier literature (Agyare et al., 2018).

Table 3.

Distribution of informants according to age group.

Age range	Percentage %
[19–20] [21–30] [31–40] [41–50] [51–60] greater than 60 No answer	2.33 31.67 23.33 17.33 15.33 73

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The treatment of cancer with traditional medicines in the study area goes back to many decades ago according to the informant’s response. The results of the present survey summarize the old traditional use of herbal medicine in fighting cancer in the Fez Meknes region (Table 4).

Table 4.

Recipes used to treat cancer in the fez-Meknes region.

Recipe	Scientific name	Preparation mode	Administration route
Jeljlān Sanouj lkhal Sanouj lhmar	Sesamum indicum L. Nigella sativa L. Lepidium sativum L.	Powders mixed with olive oil	Oral
Habat lhalwa Fliyo Zaatar Z'ītra	Pimpinella anisum L. Mentha pulegium L. Origanum vulgare L. Satureja granatensis (Boiss. & Reut.) Sennen & Mauricio	Powder Powder Powder Powder	Oral
Haba souda Tūma	Nigella sativa L. Allium sativum L.	Powder Raw form (Mixed with honey)	Oral
Merrīwut Magraman	Marrubium vulgare L. Dittrichia viscosa (L.)	Powder Powder	Vaginal inhalation
Khizou Hommṣ Laft Kebbar Jeljlān	Daucus carota L. Cicer arietinum L. Brassica rapa L. Capparis spinosa L. Sesamum indicum L.	Maceration of the seeds in the water then mix with the banana juice	Oral
Horiga Marrîwet Zit Zaytūn	Urtica dioica L. Marrubium vulgare L. Olea europaea L.	Raw form (Leaves) Raw form (Aerial part) (Mixed with olive oil)	Oral
hiyār Kiwi Ma'adnūs	Cucumis sativus L. Actinidia chinensis var. deliciosa (A.Chev.) A.Chev. Petroselinum crispum(Mill.) Fuss	Juice	Oral
pBerraztem Lhaba souda	Aristolochia longa L. Nigella sativa L.	Powder Powder (Mixed with honey)	Oral
Tūma Lhaba souda	Allium sativum L. Nigella sativa L.	Raw form Powder	Oral
Bṭāṭa hizzu Barba Krāfes	Solanum tuberosum L. Daucus carota L. Beta vulgaris L. Apium graveolens L.	Boiled and plucked	oral
ṯūma Skenjbīr	Allium sativum L. Zingiber officinale Roscoe	Raw form Powder (Mixed with eggs)	oral
ma'adnūs l-beṣla hamra	Petroselinum crispum(Mill.) Fuss Allium cepa L.	Raw form Raw form	Oral
Khorchf sekoum	Cynara cardunculus L. Euphorbia resinifera O.Berg	Raw form (Steems) Powder (roots, steems) + Water	Oral
borrō ma'adnūs	Allium ampeloprasum L. Petroselinum crispum(Mill.) Fuss	mixed with honey and lemon juice	Oral

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Anticancer activity of the main reported plants in our survey against breast, leukemic, cervical lymphoma, laryngeal, lung, liver, and kidney cancers has already been investigated in previous research works to have significant anticancer effects under both in vitro and in vivo conditions as shown in Table 5. Apteranthes europaea (Guss.), Nigella sativa L., Zingiber officinale Roscoe, Petroselinum crispum (Mill.) Fuss, and Capparis spinosa L. showed an antiproliferative activity on breast cancer cell lines (Amrati et al., 2020a); (Periasamy et al., 2016); (Rahman et al., 2011); (Farshori et al., 2013); (Aljaiyash et al., 2014), Artemisia herba-alba Asso, Allium cepa L., and Olea europaea L. on leukemic cell lines (Khlifi et al., 2013);(Votto et al., 2010);(Fares et al., 2011). Marrubium vulgare L. and Linum usitatissimum L. on cervical cancer cells (Zarai et al., 2011); (Joseph et al., 2020) by the time Aristolochia longa L.and Curcuma longa L. on lung cancer (Hinou et al., 1990); (Wu et al., 2010). Trigonella foenum-graecum L. found effective vs. T-cell lymphoma (Alsemari et al., 2014). Berberis hispanica Boiss. & Reut. vs. human laryngeal cancer cells Hep-2 (Boudjlida et al., 2019). In vivo tests showed an important effect of Allium sativum L. on the reduction of the frequency progression of colorectal adeno carcinoma and bladder cancers (Wargovich, 1987) (Table 5).

Table 5.

Literature about medicinal plants used to fight cancer in the Fez-Meknes region.

Plants	The medical interest of the inventoried plants according to the literature	Ethnopharmacological use
Apteranthes europaea (Guss.) Murb.	Cytotoxic activity on MDA-MB-231 and MCF-7 lin cells of breast cancer (Amrati et al., 2020b).	Anti-inflammatory, ulcer, antidiabetic, and anti-bacterial (Adnan et al., 2014)
Aristolochia longa L.	Apoptogenic activity on Burkitt’s lymphoma BL41 cells (Benarba et al., 2012).	Abortifacient, sedative, analgesic, anti-inflammatory, anti-feedant, muscle relaxant, antihistaminic, and anti-allergic (Benarba and Meddah, 2014).
Aristolochia longa L.	Cytotoxic activity against lymphocytic leukemia (P-388) and bronchial epidermoid carcinoma of human origin (NSCLCN6) (Hinou et al., 1990).
Nigella sativa L.	Anticancer activity on human breast cancer cells: MCF-7 (Periasamy et al., 2016).	Treatment of rheumatoid arthritis, diabetes, asthma, Obesity, and other metabolic disorders (Namazi et al., 2018).
Nigella sativa L.	Anticancer effect on human lung carcinoma (A549), larynx epidermoid carcinoma (HEp-2), colon adenocarcinoma (HT-29), and pancreas carcinoma (MIA PaCa-2) (Rooney and Ryan, 2005).
Allium sativum L.	Reduction of the frequency progression of colorectal adeno carcinoma (Wargovich, 1987)	Prevention and treatment of atherosclerosis, cardiovascular, hyperlipidemia, thrombosis, hypertension, microbial infections, diabetes, and asthma (Lyantagaye, 2011).
Allium sativum L.	Treatment of bladder cancer (Lamm and Riggs, 2000)
Marrubium vulgare L.	Cytotoxic activity against the cervical cancer lines: HeLa cells (Zarai et al., 2011).	Neurosedative and anti-inflammatory (Sahpaz et al., 2002).
Trigonella foenum-graecum L.	Cytotoxic effect against T-cell lymphoma (Alsemari et al., 2014).	Antidiabetic, carminative, tonic, and antinociceptive (Hamza et al., 2012); (Javan et al., 1997); (Zia et al., 2001).
Artemisia herba-alba Asso.	Antiproliferative activity against P815 and BSR kidney carcinoma cell lines (Tilaoui et al., 2015).	Treatment of infectious diseases, inflammatory disorders (colds, coughing, bronchitis, diarrhea), diabetes, neuralgias, antiseptic and against skin diseases, scabies, syphilis, fever as well as menstrual and nervous disorders (Abu-Darwish et al., 2015).
Artemisia herba-alba Asso.	Anticancer activity against human bladder carcinoma RT112, and human myelogenous leukemia K562 (Khlifi et al., 2013).
Allium cepa L.	Cytotoxic activity vs. multidrug resistant erythroleukemic cell lines: (Lucena and K562) (Votto et al., 2010).	Blood purifier, infectious diseases, digestive problems, skin diseases, metabolic disease, insect bites (Teshika et al., 2018).
Allium cepa L.	Apoptosis and suppression of Bcl-2 through inhibition of PI3K/Akt Signaling Pathway in AGS human cancer cells (Lee et al., 2014).
Berberis hispanica Boiss. & Reut.	Apoptotic effect in human laryngeal cancer cells Hep-2 (Boudjlida et al., 2019).	Treatment of gastrointestinal affections, liver inflammation, and biliary disorders (el Hamsas el Youbi, 2011)
Zingiber officinale Roscoe	Ameliorate chemotherapy- induced nausea and vomiting (Jagetia et al., 2003).	Treatment of airway infections, nausea, and spasm (Moghaddasi and Haddad Kashani, 2012), (Chang et al., 2013).
	Anticancer activity against human breast carcinoma cell lines (MCF-7 cancer cells and MDA-MB-231 (Rahman et al., 2011).
	Effect on cancer cell growth of human Hela cancer cells (Cheng et al., 2011).
Petroselinum crispum (Mill.) Fuss	Induction cell death in MCF-7 cells (Farshori et al., 2013).	Treatment of gastrointestinal disorder, inflammation, halitosis, kidney stone, amenorrhoea, dermatitis, headcool, vision performance, hemorrhoid (Farzaei et al., 2013).
Petroselinum crispum (Mill.) Fuss	Reduction of the cell viability of HepG2 (Human Hepatocellular Carcinoma Cells) (Farshori et al., 2014).
Olea europaea L.	Anti-proliferative activity on human leukemic cell line (Jurkat) (Fares et al., 2011).	Hypertension, inflammatory diseases, diabetes, diarrhea, respiratory and urinary tract infections, stomach, intestinal diseases, asthma, and rheumatism (Scheffler et al., 2008), (Song et al., 2019).
Olea europaea L.	Anti-cancer effect on human BRAF melanoma cells (Ruzzolini et al., 2018).
Curcuma longa L.	Cytotoxic activity against lymphocytes and Dalton's lymphoma cells (Kuttan et al., 1985).	Biliary disorders, anorexia, cough, diabetic wounds, hepatic disorders, rheumatism and sinusitis (Kumar and Sakhya, 2013).
	Anti-tumor activity against Ehrlich ascites tumour (Ruby et al., 1995).
	Induction of apoptosis in human cell lung cancer NCI-H460 cells 37 (Wu et al., 2010).
Linum usitatissimum L.	Anticancer effect against Human cervical cancer cell line: Hela cells (Joseph et al., 2020).	Diarrhea, gastrointestinal infections, asthma, cough, bronchitis, pneumonia, renal colic, renal calculi, rheumatic swelling (Khan et al., 2017).
Linum usitatissimum L.	Inhibition of Jeg3 cell growth by the phytoestrogens isolated from Linum usitatissimum L. (Abarzua et al., 2007).
Capparis spinosa L.	Cytotoxic activity against both breast and colon cell lines: MCF-7 and HCT-116 (Aljaiyash et al., 2014).	The treatment of rheumatism, gout and abdominal pains (Maresca et al., 2016).
Erodium guttatum (Desf.) Willd.	No data	Wound healing (Helmstädter, 2017).
Camellia sinensis (L.) Kuntze	Suppression of the growth of prostate cancer (HH870 and DU145) and epithelial ovarian cancer cell lines (HH450 and HH639) (Ravindranath et al., 2006).	Stimulant, diuretic, astringent, heart health, flatulence, regulating body temperature and blood sugar, promoting digestion, and improving mental processes (Chopade et al., 2008).
Origanum vulgare L.	Anticancer activity against cervical cancer line: Hella cells (Koldaş et al., 2015).	Treatment of respiratory, cutaneous infections, igestive disorders, headaches, sore throats or colds (Vale-Silva et al., 2012), (de Torre et al., 2020).
Origanum vulgare L.	Apoptosis in human colon cancer caco2 cells (Savini et al., 2009).
Salvia officinalis L.	Cytotoxic activity on colon cancer: HCT-116 cells (El Hadri et al., 2010).	Treatment of emmenagogue, cold, throat infections, skin diseases, ulcers, laryngitis, inflammation, bronchitis and Alzheimer’s disease (Sharma et al., 2019).
Peganum harmala L.	Antitumor effect on Lewis Lung, sarcoma180 and HepA tumor (Chen et al., 2005)	Antihypertensive, blood purifier, Antidiarrheal, intestinal pain, Antispasmodic in colic, Against nervosity, Emmenagogue, antalgic, Antidiabetic, Anti-pyretic (Moloudizargari et al., 2013).
Peganum harmala L.	Antiproliferative effect on leukemic cell line cells of Jurkat (Lamchouri et al., 2013)
Lepidium sativum L.	Apoptosis in human breast cancer cells: MCF-7 cell lines (Mahassni and Al-Reemi, 2013).	Treatment of chronic liver and spleen complaints, inflammatory rheumatic pains, skin diseases, asthma, diarrhea (Divanji et al., 2011).
Opuntia ficus-indica (L.) Mill.	Anticancer activity on Ehrlich ascites carcinoma cells (Abou-Elella and Ali, 2014).	Treatment of burns, wounds, edema, diabetes, obesity, indigestion, hyperlipidemy, viral and inflammatory infections (Kaur et al., 2012).
Opuntia ficus-indica (L.) Mill.	Apoptosis activity in human chronic myeloid leukemia Cell line-K562 (Sreekanth et al., 2007).
Rosmarinus officinalis L.	Antiproliferative effect on human ovarian cancer cells (A2780 and A2780CP70) (Tai et al., 2012).	Analgesic, anti-inflammatory, anti-rheumatic, spasmolytic, carminative and choleretic applications (Minaiyan et al., 2011).
Rosmarinus officinalis L.	Anticancer Effect on CaCo-2 colon cancer cells (Moore et al., 2016).
Ficus carica L.	Anti-angiogenic activity on human umbilical vein endothelial cells (Mostafaie et al., 2011)	Treatment of gastrointestinal disorders (colic, indigestion, loss of appetite, and diarrhea), respiratory (sore throats, cough, and bronchial problems), inflammatory, and cardiovascular disorders (Mawa et al., 2013).
di Punica granatum L.	Induction of apoptosis in prostate cancer cell line (Sineh Sepehr et al., 2012).	Treatment of atherosclerosis, diabetes,hypertension, hyperlipidemia, cancer, peptic ulcer and oral diseases (Ge et al., 2021).
di Punica granatum L.	Anticancer activity on human cancer cell lines melanoma (A375), colon cancer (HCT116), and hepatocellular carcinoma (HepG2) (Joseph et al., 2013).
Cuminum cyminum L.	Cytotoxic activity against colon cancer cells (502713, Colo-205, Hep-2, A-549, OVCAR-5, PC-5, SF-295) (Prakash and Gupta, 2014).	Treatment of asthma, bronchitis, rheumatism, hypolipidemia, cancer, diabetes and other inflammatory diseases (Mnif and Aifa, 2015), (Srinivasan, 2018).
Apium graveolens L.	Anticancer activity vs. rhabdomysarcom (RD) and murine (L20B) (AL-Jumaily, 2018).	Treatment of spasm, stomach problems, used also as diuretic, laxative, and sedative, and to lower the blood pressure (Al-Asmari et al., 2017).
Daucus carota L.	Antiproliferative effect on human Lymphoid Leukaemia Cells 67 (Zaini et al., 2012).	Treatment of gastric disorders, acidity and gastric ulcers (Nayeem et al., 2010)
Daucus carota L.	Anticancer effect against human colon (HT‐29, Caco‐2) and breast (MCF‐7, MDA‐MB‐231) cancer cell (Shebaby et al., 2013).
Dittrichia viscosa (L.)	Antiproliferative and apoptosis effects on breast cancer cells (MCF-7) (Talib et al., 2012).	Wound healing, herniated disc, stomachache, anticancer, kidney pain, kidney stones, skin, hair, eye ailments and cancer (Sevgi et al., 2021).
Sinapis alba L.	Anticancer effect on colon cancer cell lines (SW480) (Yuan et al., 2011).	Anti-tumor, antiviral, and analgesic agent (Mitrović et al., 2020).
Sinapis alba L.	Suppression of colonic cancer (Zhu et al., 2012).
Origanum majorana L.	Apoptotic and anti-proliferative activity on human lymphoblastic leukemic cell line (Jurkat) (Abdel-Massih et al., 2010).	Treatment of insomnia, gastritis, asthma and nervousness (Singla and Vasudeva, 2015).
Origanum vulgare L.	Anticancer activity on human lung cancer cell line (A549) (Sankar et al., 2013).	Digestive and circulatory stimulant, antispasmodic, calmative, carminative, diaphoretic, expectorant, stomachic agent (de Torre et al., 2020).
Hordeum vulgare L.	Inhibition of oxidative DNA damage and apoptosis (J. B. Jeong et al., 2009).	Treatment of inflammatory, cardiovascular diseases, obesity, diabetes, circulatory disorders, arthritis, anemia, excessive cholesterol levels, renal difficulties, and cancer (Gul et al., 2014), (Thatiparthi et al., 2019).
Hordeum vulgare L.	Antitumor effect in mammary carcinogenesis (Kubatka et al., 2016).
Vitis vinifera L.	Anticancer effect on liver (HepG2) and cervical (HeLa) cancer cells (Apostolou et al., 2013).	Treatment of diarrhea, hepatitis and stomachaches (Aouey et al., 2016).
Ephedra alata Decne	Antiproliferative and pro-apoptotic potential against the MCF-7 breast cancer cell line (Danciu et al., 2018).	Treatment of allergies, asthma, colds, coughs, edema, fever, headaches, and nasal congestion (Mighri et al., 2019).
Drimia maritima (L.) Stearn	Cytotoxicity on lung cancer cell lines (A549) (Bozcuk et al., 2011).	No data
Pinus halepensis Mill.	Antiangiogenic activity on adenocarcinoma of human basal epithelial cells (A549), human colon adenocarcinoma (HCT15) and human myeloma (HL60) (Kadri et al., 2014).	Treatment of diarrhea, wounds, rheumatism, cough, gastrointestinal illnesses, hypertension, and hemorrhoids, used also as antiseptic, astringent, antifungal, and anti-tuberculosis (El Omari et al., 2021).
Urtica dioica L.	Antiproliferative activity on human prostate cancer cells (LNCaP, hPCPs) (Konrad et al., 2000).	Used as antihypertensive blood purifier, emmenagogue, diuretic, as well as to treat menstrual hemorrhage, rheumatism, and eczema (Testai et al., 2002), (Ilhan et al., 2019)
Citrus aurantium L.	Induction of G2/M phase arrest and apoptosis in human gastric cancer AGS Cells (Lee et al., 2012).	Treatment of influenza, insomnia, used also as tranquilizer, cardiovascular analeptic, and antispasmodic (Karthikeyan, 2014).
	Induction of the cell cycle arrest and apoptosis in lung cancer cells (A549) (Park et al., 2012).
	Cytotoxic effect on human colorectal carcinoma cell line (lim1863) (Odeh et al., 2012).

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Some plant species are used against cancer in the study area despite their toxicities such as Apteranthes europaea Guss (Issiki et al., 2017), Aristolochia longa L. (Benarba et al., 2017), Capparis spinosa L. (Fanoudi et al., 2017), Nigella sativa L. (Zaoui et al., 2002), Artemisia herba-alba Asso. (Bertella et al., 2018), Berberis hispanica Boiss. & Reut. (Kheir et al., 2010), Peganum harmala L. (Lamchouri et al., 2002), Origanum vulgare L. (Yazdani et al., 2014), Urginea maritima (L.) Baker (Tuncok et al., 1995), Citrus aurantium L. (Arbo et al., 2009), and Rosmarinus officinalis L. (Anadón et al., 2008) (Table 5).

In the present survey, many respondents have little data regarding plant toxicities due to illiteracy (Fig. 2.a) and the limited understanding of product toxicity. Collected data reported some contradiction in terms of the efficiency and toxicity of some reported plants .i.e. genus Aristolochia was highly recommended by the informants to treat cancer by contrast many scientific studies have demonstrated severe toxic effects with irreversible kidney tissue lesions induced by aristolochic acid contained in this genus. This phenomenon reflects some misunderstanding of traditional medicine based on traditions rather than sciences. It is thus researchers should work on creating awareness among people regarding the inconvenience of plant use without scientific validity.

The antitumor effect of some bioactive compounds contained in the inventoried plants was also discussed in the previous works. Previously published literature investigated the chemical compounds related to potential anticancer effects of some inventoried plant species in the current research such as hesperetin (Choi, 2007), quercetin, myricetin (Lu et al., 2006), ferulic acid (Yang et al., 2015), and gallic acid (Chen et al., 2009) contained in Apteranthes europaea (Guss.) Murb (Amrati et al., 2020a), (Amrati et al., 2021), aristolochic acid I (AAsI) and aristolactam la (ALIa) in Aristolochia longa L. (Hinou et al., 1990), thymoquinone, and alpha-hederin in Nigella sativa L.(Rooney and Ryan, 2005); (Adamska et al., 2019), diallyl sulfide in Allium sativum L.(Wargovich, 1987), β-caryophyllene and α-humulene components in Marrubium vulgare L.(Fidyt et al., 2016); (El Hadri et al., 2010) ; protodioscin in Trigonella foenum-graecum L. [31; 100] (Ma et al., 2019) ; (Alsemari et al., 2014) flavonoids and tannins in Artemisia herba-alba Asso (Khlifi et al., 2013), quercetin in Allium cepa L. (Votto et al., 2010), 6-gingerol, and 6-shogaol in Zingiber officinale Roscoe (C.-H. Jeong et al., 2009) ; (Wu et al., 2015) ; (Cheng et al., 2011) ; Oleuropein in Olea europaea L. (Ruzzolini et al., 2018), curcuminoids in Curcuma longa L. (Anto et al., 1995) ; (Hsiao et al., 2018) ; glabranine and naringenin in Linum usitatissimum L. (Joseph et al., 2020), and Epicatechins in Camellia sinensis (L.) Kuntze (Ravindranath et al., 2006); (Bitu Pinto et al., 2015). The chemical structures of the mentioned compounds are presented in Fig. 7.

Fig 7 — Chemical structures of compounds involved in the anticancer effect of some inventoried plant species.

In the present survey, many respondents have little data regarding plant toxicities due to illiteracy and the limited understanding of product toxicity. Collected data reported some contradiction in terms of the efficiency and toxicity of some reported plants. i.e. genus Aristolochia was highly recommended by the informants to treat cancer by contrast many scientific studies have demonstrated severe toxic effects with irreversible kidney tissue lesions induced by Aristolochic acid contained in this genus. This phenomenon reflects some misunderstanding of traditional medicine based on traditions rather than sciences. For this reason, researchers should work on creating awareness among people regarding the inconvenience of plant use without scientific validity.

4. Conclusion

The present survey provides comprehensive data about the medicinal plant used in the Fez-Meknes region in Morocco for cancer treatment. The outcome of the present work showed that traditional medicines are still largely used among the rural and urban tribes of the region as a weapon to fight cancer. This study makes its way to contribute towards society as it provides a detailed study on the medicinal plants including plant parts used, mode of preparation, route of administration, as well as doses that find a place in cancer-fighting. This work hoping to constitute valuable data that can serve as medicines to develop natural anticancer compounds.

Author’s contribution

F.E.Z,. M.B., M.S.: writing the original Draft. A.M.S., A.A., R.U.: reviewing, and editing. A.B.,D.B.: Supervision and data validation

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding this work through research group.

no (RG-1441-360).

Footnotes

Peer review under responsibility of King Saud University.

Contributor Information

Fatima Ez-Zahra Amrati, Email: fatima.ezzahra.amrati@gmail.com.

Mohammed Bourhia, Email: bourhiamohammed@gmail.com.

References

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PERMALINK

Traditional medicinal knowledge of plants used for cancer treatment by communities of mountainous areas of Fez-Meknes-Morocco

Fatima Ez-Zahra Amrati

Mohammed Bourhia

Meryem Slighoua

Ahmad Mohammad Salamatullah

Abdulhakeem Alzahrani

Riaz Ullah

Amina Bari

Dalila Bousta

Background

1. Introduction

2. Materials and methods

2.1. Study area

Fig. 1.

2.2. Data collection

2.3. Data analysis

2.3.1. Relative frequency of citation

2.3.2. Fidelity level

3. Results and discussion

Table 1.

Table 2.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

Table 3.

Table 4.

Table 5.

Fig 7.

4. Conclusion

Declaration of Competing Interest

Acknowledgments

Acknowledgments

Footnotes

Contributor Information

References

ACTIONS

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