South African Journal of Botany 111 (2017) 12–16
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An ethnobotanical survey of traditional medicinal plants used against lymphatic ﬁlariasis in South Africa L. Komoreng a,⁎, O. Thekisoe b, S. Lehasa a, T. Tiwani a, N. Mzizi a, N. Mokoena a, N. Khambule a, S. Ndebele a, N. Mdletshe a a b
Department of Plant Sciences, University of the Free State, Private Bag X13, Phuthaditjhaba 9866, South Africa Unit for Environmental Sciences and Management, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
a r t i c l e
i n f o
Article history: Received 1 February 2017 Received in revised form 23 February 2017 Accepted 9 March 2017 Available online xxxx Edited by J Van Staden Keywords: Ethnobotany Medicinal plants Traditional healers Lymphatic ﬁlariasis Lymphoedema
a b s t r a c t Lymphatic ﬁlariasis is a condition where the skin thickens and hardens after excessive swelling associated with lymphoedema. The condition is caused by infection with parasites classiﬁed as nematodes. In this study, an ethnobotanical survey of medicinal plants used against lymphatic ﬁlariasis in the Eastern Cape, Free State, KwaZuluNatal and Mpumalanga Provinces of South Africa was conducted through the use of structured questionnaires. Information was gathered from 21 traditional healers, 9 herbalists and 12 elderly people. The respondents were asked questions regarding their use of medicinal plants to treat lymphatic ﬁlariasis and related ailments. Information entailing plants used to treat lymphatic ﬁlariasis, plant parts used, mode of preparation and dosage was recorded. The information collected revealed 46 medicinal plants belonging to 28 families were used against lymphatic ﬁlariasis. Members of the Asteraceae family were the most prominent, followed by Hyacinthaceae, Euphorbiaceae and Solanaceae. It was interesting to note that different traditional healers from the four Provinces use similar plants to treat lymphatic ﬁlariasis. The most frequently mentioned plants were Elephantorrhiza elephantina, Eucomis autumnalis, Ganoderma sp., Solanum aculeastrum, Hermannia geniculata, Datura stramonium and Pentanisia prunelloides. Leaves and underground plant parts were reported to be the most commonly used plant parts. The most prominent methods of herbal administration used were orally and soaking of the affected body part. This study has documented important ethnobotanical information on medicinal plants used by South African healers and indigenous people in the treatment of lymphatic ﬁlariasis and related diseases. © 2017 SAAB. Published by Elsevier B.V. All rights reserved.
1. Introduction Lymphatic ﬁlariasis (LF), commonly known as elephantiasis, is a sign of a variation of illnesses where parts of a person's body swell to enormous proportions. LF is characterized by thickening and hardening of the skin and subcutaneous tissue that results in grossly enlarged and very swollen limbs due to lymph accumulation (lymphoedema) (Mandal, 2014). The disease is mostly noticeable in the lower limbs, but also commonly affects breasts, arms and the scrotum in males. This is one of the most painful and intensely disﬁguring diseases. LF is caused by infection with round ﬁlarial parasites classiﬁed as nematodes. The three types of ﬁlarial worms are Wuchereria bancrofti (which is responsible for 90% of the cases), Brugia malayi and Brugia timori (WHO, 2016).
Abbreviations: DEC, diethylcarbamazine; LF, lymphatic ﬁlariasis; WHO, World Health Organization. ⁎ Corresponding author at: Department of Plant Sciences, Faculty of Natural and Agricultural Sciences, University of the Free State, Private Bag X13, Phuthaditjhaba 9866, South Africa. E-mail address: [email protected]
http://dx.doi.org/10.1016/j.sajb.2017.03.005 0254-6299/© 2017 SAAB. Published by Elsevier B.V. All rights reserved.
According to WHO (2014), more than 1.4 billion people in 73 countries are living in areas where LF is transmitted and are at risk of being infected. Currently, over 120 million people are affected by the infection, with 40 million people showing chronic disease symptoms (Molyneux, 2003; WHO, 2009; Maurya et al., 2015). One third of the people infected with LF live in India, one third in Africa and the remainder in South-East Asia, the Paciﬁc, New Guinea and the Americas (Wynd et al., 2007). Within the African region, LF is endemic in 39 countries and the population at risk is estimated at 390 million (Zagaria and Savioli, 2002; Simonsen et al., 2008). South Africa is also burdened by LF, and according to a report by eNCA (2013), treating the disease remains a problem in South Africa. The unavailability of statistical data on LF adds to the problem. Approximately 31% of the South African population are at risk of being infected with bancroftian ﬁlariasis (Berger, 2014), with 530,000–1.06 million people having some form of lymphoedema (Davey, 2014). In a report published by Dlamini (2011) and eNCA (2013), patients are often turned away from some of the public hospitals in South Africa, reasons being that there is no treatment in the country or that the disease needs specialist care. People who are affected by this disease suffer from disability, as well as social and ﬁnancial losses contributing to
L. Komoreng et al. / South African Journal of Botany 111 (2017) 12–16
stigma and poverty (Evans et al., 1993, Ramaiah and Ottesen, 2014, Maurya et al., 2015). Prevention of LF is possible by stopping the spread of the infection (WHO, 2014). Its treatment involves a dose of albendazole together with ivermectin or diethylcarbamazine (DEC). Antibiotics may also be used to treat bacterial cellulitis which arises secondary to massive lymphoedema and elephantiasis. Unfortunately, these drugs are ineffective against adult worms, which are the ones that cause the disease (Debrah et al., 2007; Maurya et al., 2015). In addition, Netcare Foundation is providing funds for the treatment of elephantiasis, however, due to the lengthy process, the selection criteria for being accepted onto the programme are strict, resulting in a small number of patients being eligible (Netcare Limited, 2013). Hence, there is a need for an alternative treatment that is cheaper and as effective as allopathic management of the disease. Treating elephantiasis using medicinal plants is a common practice in some parts of the world. There are several herbs that have been prescribed by Ayurvedic medicine, for example, to treat elephantiasis, and some of them have been used for centuries (Agrawal, 1997; Gupta and Tandon, 2004). This study was aimed at gathering information from herbalists and traditional healers on traditional medicinal plants used to treat LF from four provinces in South Africa. 2. Materials and methods
sub-tropical temperatures and experiences high summer rainfalls. This area receives mean rainfall of 620 mm between September and March per annum, and due to the moist climate, the lowveld is a perfect home for mosquitoes to thrive in (SouthAfrica.info, 2015). 2.2. Data collection Data was collected between February 2015 and October 2016. Information was compiled through general conversations with the informants while structured questionnaires were used to obtain additional information about the methods of treatment (Jovel et al., 1996). The main aim and vision of the interviews were explained to the participants and they consented to share their knowledge with us. Their consent to publish the ﬁndings was obtained before questioning. The information that was recorded included the age group and gender of the persons interviewed, common names of the plants used, their local uses, parts of the plants used, the mode of preparation and forms of administration of the medicinal plants. Ethical clearance was obtained from the University of the Free State. Plants were collected with the assistance of the traditional healers and herbalists. They were initially identiﬁed by their common names and proper identiﬁcation was done by Dr. E.J.J. Sieben and voucher specimens were prepared and deposited at the herbarium of the University of the Free State (QwaQwa Campus).
2.1. Study area 3. Results and discussion Ethnobotanical surveys were conducted from the Eastern Cape (Intsika Yethu and Nkonkobe Municipal areas), Free State (Dihlabeng, Maluti-a-Phofung and Nketoana municipal areas), KwaZulu-Natal (Abaqulusi and eThekwini municipal areas) and Mpumalanga (Nkomazi municipal area) Provinces of South Africa. The Free State is an inland bean-shaped Province of South Africa. It is the third largest Province; covering about 10.6% of the country's total area and provides for most of the commercial farming of South Africa (SouthAfrica.info, 2015). Four biomes found within the Province are grassland, Nama Karoo, savannah and forest; with 37 vegetation units found within these biomes (Mucina and Rutherford, 2006). The eastern part of the Free State consists of cool to very cold winters, especially towards the mountainous regions, and warm to hot rainy summer days. The Eastern Cape is a second largest Province, covering about 13.8% of the county's total area (South African Government, 2014). Maputaland-Pondoland Albany, the second biodiversity hotspot of South Africa is found in this Province. It is dominated by closed shrublands, low forests with evergreens, succulent trees, vines and shrubs (Hamann and Tuinder, 2012). It is characterized by the southern Drakensberg Mountains, ragged cliffs, northern tropical forest and dense bushes. Indigenous forest plants include yellowwoods, white stinkwood and many exotic plants (Hamann and Tuinder, 2012). The Eastern Cape displays a rainfall pattern with two modes, a winter rainfall zone in the west, and a summer rainfall zone in the east (Hamann and Tuinder, 2012). KwaZulu-Natal consists of three distinct geographical areas, the lowland Indian Ocean coastal region, the central Natal Midlands and the mountainous areas of the Drakensberg and Lebombo Mountains. Savannah grassland and areas of indigenous forest are found between the mountains and the humid, subtropical coastline (SouthAfrica.info, 2015). The area is characterized by a fragmented distribution of medicinal plant species due to the varied land use, topography and climate (Mander, 1998). Kwazulu-Natal is a summer rainfall area, with extremely hot temperatures in summer and heavy snow on the mountains in winter (SouthAfrica.info, 2015). Mpumalanga is a Province where the climate varies due to its topography. The Mpumalanga climate changes from the highveld to the lowveld area, and the vegetation in each area is determined by the climate it experiences. The lowveld has a tropical climate, with warm
The ethnobotanical list with detailed information is presented in Table 1. Information was gathered from 21 traditional healers (12 females and 9 males), 9 herbalists (all males) and 12 elderly people (4 females and 8 males). The ages of the informants ranged from 28 to 80 years old. During the ethnobotanical survey, it was established that all the informants frequently used medicinal plants to treat LF and the related diseases. It was interesting to note that traditional healers/herbalists from the different Provinces use the same plants, but had varying common names, to treat LF. For example, Elephantorrhiza elephantina was used by traditional healers from the Eastern Cape, Free State and KwaZulu-Natal to treat LF. In the Eastern Cape and KwaZulu-Natal the plant is known by Intolwane, whereas in the Free State it is known by Mositsane. All the informants mentioned that they collect plants from the veld. They only cultivate those that are difﬁcult to access. The study revealed that 46 medicinal plants belonging to 28 families were used to treat LF and related ailments in South Africa. Members of the Asteraceae family were the most prominent with 7 species, followed by Hyacinthaceae with 6 species, Euphorbiaceae with 4 species and Solanaceae with 3 species. The rest of the families were represented by either one or two species each. Seven plants were frequently mentioned for the treatment of LF and related ailments by the traditional healers and herbalists from the Eastern Cape, Free State and KwaZuluNatal Provinces. These included E. elephantina, Eucomis autumnalis, Ganoderma sp., Solanum aculeastrum, Hermannia geniculata, Datura stramonium and Pentanisia prunelloides. Dicoma anomala, E. elephantina, and P. prunelloides have been reported to treat and manage a wide range of ailments in Lesotho and are, thus, in high demand (Kose et al., 2015). Plants could be used individually or in combination to treat LF. For example, one of the traditional healers from the Eastern Cape treated LF by using a mixture that contained equal portions of Eucomis comosa, Euphorbia clavarioides and Rumex obtusifolius. Ricinus communis, Drimia depressa, D. stramonium, S. aculeastrum, E. autumnalis, and Withania somnifera have been reported to possess toxic compounds though they are used for medicinal purposes (Taylor and Van Staden, 2001; Van Wyk et al., 2002; Ndhlala et al., 2013; Kose et al., 2015). These plants should, therefore, be handled with care and not be used without proper supervision.
L. Komoreng et al. / South African Journal of Botany 111 (2017) 12–16
Table 1 Medicinal plants used for the treatment of lymphatic ﬁlariasis in South Africa. Family name
Plant part used
Method of preparation and administration
Tulbaghia alliacea L.f.
Achyropsis avicularis E.Mey. ex Moq. Alepidea amatymbica Eckl. & Zeyh. Ilex mitis (L.) Radlk.
Decoction and infusion used to treat swelling and wounds associated with ibekelo. Leaves are used to clean wounds.
Acorus calamus L.
Mots'ets'e Umsenge Phoa
FS EC FS
Cussonia paniculata Eckl.& Zeyh. Aster bakerianus Burtt Davy ex C.A.Sm. Berkheya setifera DC. Dicoma anomala Sond.
Rhizome/roots An infusion is made and taken internally for pain and inﬂammation. Leaves Leaves are rubbed for producing a lather that is applied externally Rhizome/roots Traditionally taken as a tea. May be used externally as a bath additive Leaves Leaf infusion is used to clean wounds and soak swollen limbs.
Eriocephalus L. sp.
Asteraceae Asteraceae Asteraceae Balanophoraceae
Felicia erigeroides DC. Platycarpha glomerata Less. Senecio speciosus Willd. Sarcophyte sanguinea Sparrm. Kigelia Africana (Lam.) Benth. Chenopodium ambrosioides L. Capparis tomentosa Lam.
Bignoniaceae Chenopodiaceae Capparaceae
Decoction and infusion taken internally as an anthelmintic.
Roots Roots, leaves
Sehalahala sa matlaka
Ixhaphozi Umthuma Idambisa Umavumbuka
Whole plant Roots Leaves Rootstock
KZN EC KZN EC, KZN MP
The decoction helps get rid of excess ﬂuid in the body. Poultice is prepared with leaves to treat wounds. Root decoction is taken internally for infection. Infusion is used as a purgative for parasites and to treat skin infections. Infusion is used as a purgative for parasites. Treatment for wounds, swelling, pain. Leaf infusions are used to relieve pain and inﬂammation. Decoction is taken for pains and inﬂammation. It can be externally applied to treat sores. Infusion is used to treat skin infections.
Tea is prepared and taken at 2–3 hour intervals.
Indoda-ebomvu Intsihlo Ubhoqo Mothokho
MP EC EC, MP FS FS
Leaves and roots Roots
Decoction used to treat wounds and skin problems.
Infusion and decoction used to treat inﬂammation.
Leaves Whole plant Whole plant Whole plant
Leaves are made into a poultice to treat sore legs. Infusion and decoction used for easing inﬂammation. Concoction is drank three times daily. Can also be used to bath to treat wounds, swelling and skin problems Used to treat wounds, swelling and skin problems
Leaves and young roots. Roots and rhizomes
Leaves and roots used to treat headaches, pains and relieving clots from the body. The infusion of the inner parts of the roots is administered as enema
A powder diluted with water is taken orally as an anthelmintic.
It is externally applied to treat sores.
The irritant foam caused by adding water to the bark is used to treat fever and heal wounds. The whole plant is boiled and taken internally as an anthelmintic. Bulbs and root shavings are boiled in water or milk and used as ingredients in infusions to treat pain and fever Decoctions of the bulb in water or milk are usually administered as enemas.
Ipomoea oblongata E.Mey. ex Choisy
Dioscorea sylvatica (Burch.) Marakalla/Leeto la tlou Spreng Var. Croton sylvaticus Hochst. Mahlabekufeni/Umhloshozane KZN
Euphorbiaceae Euphorbiaceae Euphorbiaceae Euphorbiaceae
Euphorbia clavarioides Boiss. Euphorbia gorgonis A.Berger Ricinus communis L.
iNkalimasane Sehlehle Nkalimasane/Intsema
KZN FS EC
Elephantorrhiza Mositsane elephantina (Burch.) Skeels Intolwane
Albizia anthelmintica (A. Rich.) Brongn. Ganoderma sp.
Gunnera perpensa (L.)
Drimia depressa (Baker) Jessop Eucomis bicolor Baker.
Ugobho Qobo Moretella
EC, FS, KZN KZN FS FS
Eucomis autumnalis (Mill.) Chitt
Eucomis comosa Hort. ex Wehrh. Ledebouria sp.
EC, KZN EC, FS, KZN KZN
Urginea delagoensis Baker.
Hypoxis latifolia (Baker.) Hook. Hermannia geniculata EckL. & Zeyh.
Ihlanganisa or Umahlanganisa EC, KZN Ilabatheka EC, KZN Seletjane FS Isidikili EC, KZN Ibohlololo KZN, MP Idolo lenkonyana EC
Mesembryanthemaceae Aptenia cordifolia (L.f.) Schwant. Polygonaceae Rumex obtusifolius L.
FS EC, KZN MP
Whole plant Bulb
Infusion used to soak swollen limbs.
Concoction with E. clavarioides and R. obtusifolius used to heal wounds Decoction is taken orally for fever and pain. The infusion is used to wash wounds. Decoction is used for emetic and enemas.
Infusion is taken as blood-cleansing emetic.
Infusion is taken internally for sores and inﬂammation.
Medicinally used as an anti-inﬂammatory, and as a dressing (poultice). Ground and mixed with S. aculeastrum. Concoction is drank for
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Table 1 (continued) Family name
Portulaca oleracea L.
Cassipourea ﬂanaganii (Schinz) Alston Cliffortia linearifolia Eckl. & Zeyh. Pentanisia prunelloides (Klotzsch ex Eckl. & Zeyh.) Walp. Datura stramonium L.
KZN, MP KZN
Solanum aculeastrum Dunal.
Withania somnifera (L.) Dunal Rhoicissus tomentosa (Lam.) Wild & R.B. Drumm. Rhoicissus tridentata (L.f.) Wild & R.B. Drumm.
Ubushwa Bofepha Isinwazi Umbovu Mboziso
Unwele Icimamlilo Setima mollo Umhlamvuthwa Lechoe
EC, KZN FS EC, KZN FS EC, KZN, MP EC FS KZN MP KZN, MP
Plant part used
Leaves and stem Roots and stem Leaves and stem Roots
Method of preparation and administration relief of pain associated with swollen limbs and other body parts. Crushed leaves can be applied directly to the skin. Aqueous infusion and decoction are taken orally and can be applied externally as lotion or wound dressing. Infusion is used to soak and treat swollen limbs Infusion is used to treat sores, boils and internal tumours
Roots and leaves
Concoction is taken internally as a blood puriﬁer.
Fruits and leaves are used fresh, dried, boiled, or charred (ashed) for the treatment of infestations and wounds, and swollen limbs. Root and leaf infusion is used to soak and treat swollen parts.
Roots Leaves Roots Root tuber
Boiled in milk to expel worms. Decoction using methylated spirit is used for inﬂammation.
EC: Eastern Cape; FS: Free State; KZN: KwaZulu-Natal; MP: Mpumalanga.
The informants use the whole plant or different plant parts (leaves, bark, roots, stem bark and bulbs) to treat LF. Roots, leaves and bulbs/tubers were reported to be the most commonly used plant parts, with bark and fruit being the least used plant parts. Herbalists claim to use underground plant parts most frequently, believing that they contain the highest concentration of potent healing agents (Shale et al., 1999; Appidi et al., 2008). Grinding plant material into ﬁne powder was the preparatory method that was often used for plants used in the treatment of LF. According to Mumbengegwi et al. (2015), grinding of plant material assists the solvent to penetrate the plant's cellular structure. The smaller particle sizes lead to better surface contact with extraction solvents (Azwanida, 2015). Decoction and infusion were the most commonly used methods of preparation. The survey indicated that the most prominent methods of herbal administration used were orally and soaking of the affected limb in a bath containing the herbal preparation. 4. Conclusion This study documented important ethnobotanical information on traditional medicinal plants that are used by South African healers and indigenous people in the treatment of LF and related diseases. Fortysix plants were recorded in the management of LF and related diseases. Underground plant parts are the most harvested; hence, there is a need to educate the healers about the dangers of over-harvesting these medicinal plants. Based on the information collected, screening these plants for bioactivity and for toxicity is important in order to validate the claims made by the healers. Formatting of funding sources This project was ﬁnancially supported by the Thuthuka grant of the National Research Foundation, South Africa made available to Lisa Komoreng. Acknowledgements The authors are most grateful to the herbalists and traditional healers who provided the information. Dr. Sieben is acknowledged for his assistance with plant identiﬁcation.
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