Ethnopharmacological documentation of medicinal plants used for hypertension among the local communities of DIR Lower, Pakistan

Ethnopharmacological documentation of medicinal plants used for hypertension among the local communities of DIR Lower, Pakistan

Journal of Ethnopharmacology 175 (2015) 138–146 Contents lists available at ScienceDirect Journal of Ethnopharmacology journal homepage: www.elsevie...

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Journal of Ethnopharmacology 175 (2015) 138–146

Contents lists available at ScienceDirect

Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jep

Ethnopharmacological documentation of medicinal plants used for hypertension among the local communities of DIR Lower, Pakistan Latif Ahmad a,n, Andrew Semotiuk b, Muhammad Zafar a, Mushtaq Ahmad a, Shazia Sultana a, Quan-Ru Liu c, Muhammad Pukhtoon Zada a, Sheikh Zain Ul Abidin a, Ghulam Yaseen a a

Department of Plant Science, Quaid-i-Azam University, Islamabad 45320, Pakistan Ezcurra Lab, University of California, Riverside 900 University Avenue, Riverside, CA 92521, United States c College of Life Science, Beijing Normal University, Beijing 100875, China b

art ic l e i nf o

a b s t r a c t

Article history: Received 16 April 2015 Received in revised form 9 September 2015 Accepted 12 September 2015 Available online 21 September 2015

Ethnopharmacological relevance: Local communities of the Dir Lower district in Northwest Khyber Pakhtunkhwa, Pakistan rely on botanical anti-hypertensive preparations. Insights into the traditional uses of local flora can direct investigation into phytochemical screening. Aim of the study: This ethnobotanical study aims to identify plant species and recipes used by the local people for the treatment of hypertension in the district of Dir Lower. Materials and methods: Inquiries and interviews were carried out from November 2012 to December 2013 from local herbalist and indigenous communities including village elders. Results: A total of 46 plant species (43 genera and 29 botanical families) used by local people of study area to treat hypertension. Family Lamiaceae dominated with the highest percentage 15.21% (7 species). With respect to growth form, herbs constituted (63.05%), shrubs (30.43%) and trees (6.52%). Leaves (37.25%) were the most frequently used part in herbal preparations. The major mode of preparation was decoction (46.66%) and almost all recipes were orally administered. Use values (UV) revealed that the most preferred species for the treatment of hypertension by the indigenous community are Paeonia emodi Wall. ex Royle., followed by Sarcococca saligna (D. Don) Muell. Arg., Fumaria indica (Hausskn.) Pugsley and Teucrium stocksianum Boiss. Amongst the 46 medicinal plants, antihypertensive activity of 16 plants included Artemisia vulgiris L., Artemisia annua L., Sisymbrium brassiciforme C. A. Mey., T. stocksianum Boiss, Cichorium intybus L., Rosa brunonii Lindl., Chenopodium botrys L., Olea ferruginea Royle, Cotoneaster acuminatus Lindl, S. saligna (D. Don) Muell. Arg., Viola canescens Wall. ex Roxb, P. emodi Wall. ex Royle, Asparagus gracilis Royle, Maytenus royleanus (Wall. ex Lawson), Allium jacquemontii Kunth and Onosma hispidum Wall has not been reported previously in the scientific literature. Conclusions: Dir lower is a rich and biodiverse area of medicinal plant. The large number of plant species used for hypertension in this area shows the importance of herbal medicine in the primary health care of this remote area. In future studies, the plant should be further screened for phytochemical and new medicinal properties. & 2015 Elsevier Ireland Ltd. All rights reserved.

Keywords: Ethnopharmacology Survey Hypertension Medicinal plants Dir lower

1. Introduction There are at approximately 970 million people all over the world who suffer from hypertension. Nearly 640 million people have hypertension in the developing world and 330 million people have hypertension in the developed world (WHF, 2012) and it is a major cause of mortality and morbidity worldwide. A person is

n

Corresponding author. E-mail addresses: [email protected], [email protected] (L. Ahmad). http://dx.doi.org/10.1016/j.jep.2015.09.014 0378-8741/& 2015 Elsevier Ireland Ltd. All rights reserved.

said to suffer from hypertension when his blood pressure is consistently higher than 140/90 mm Hg (Fischer et al., 2010). High blood pressure is one of the most important modifiable risk factors for cardiovascular disease (Whelton, 1994). At present, it was reported that about 1 billion people worldwide have hypertension and this number is likely to increase to 1.56 billion by 2025 (Sarafidis et al., 2008). The occurrence of hypertension is probable at about 30% of the adult population in developed countries and is predicted to increase by almost 60% in the next 2 decades (Hajjar and Kotchen, 2003). Hypertension affects more than 70 million Americans and it is the most dominant risk factor for development of kidney and cardiovascular disease (Kdoqi, 2007). A similar

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situation is seen in Pakistan, the National Health Survey of Pakistan estimated that hypertension affects 33% of all adults above 45 years old and 18% of all adults. In another report, it was shown that 18% of people in Pakistan suffer from hypertension with every third person over the age of 40 becoming susceptible to an extensive range of diseases (Saleem et al., 2010). The use of plants for medicinal purpose goes back to early man. The search for healing power in plants is an old aged idea and throughout history man has trusted on nature for shelter, food, medicines, clothing and transportation (Ahmad et al., 2006). Currently, medicinal plants are used all over developed and under developed countries of the world as traditional home remedies (Bandaranayke, 2006). Natural resources like plants and animal are promising agents for drug discovery as they play a very important role in traditional medicine (Newman and Cragg, 2007). According to the WHO about 80% of developing countries population depends on traditional medicines (Calixto, 2005). WHO reports that about 25% of all modern medicines including both western and traditional medicine are derived from plants (Bodeker and Ong, 2005). A recent review has shown that almost 25% of modern medications have been extracted from plants, while 75% of new drugs against infective diseases that have arrived between 1981 and 2002 originated from natural sources (Bedoya et al., 2009). The practice of traditional medicine is not the same all over the world but varies from country to country and region to region because their use depends on the history, culture, philosophy and personal attitudes of the users (Togola, 2008). Traditional medicine use and popularity is strong and increasing around much of the world. For example, traditional herbal medicine accounts for 30–50% of the total medicinal consumption in China. In North America, Europe and other well-developed regions over 50% of the population have used traditional preparations at least once. In 2003, it was reported that the world market for herbal medicines stood at over US $60 billion per year and is growing steadily (WHO, 2003). Indigenous cultures possess a huge store of traditional knowledge regarding herbal remedies for the treatment of various ailments, which are still not documented (Offiah et al., 2011). It has now become more important than ever to record and preserves

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the traditional knowledge of medicinal plants in order to aid the discovery of new drugs and possibly to find improved applications of traditional medicine (Koné and Atindehou, 2008). In addition, documenting the results of scientific research on traditional medicine may also help conserve an important part of an indigenous people's cultural heritage for future generations (Mahwasane et al., 2013). The aim of the present study was to collect and document information on traditional use of medicinal plants for the treatment of hypertension by the local people of District Dir Lower. It is hoped that the result of the present study will provide the basis for further pharmacological and phytochemical studies that are critical for the development of alternative anti-hypertensive drugs.

2. Material and methods 2.1. Study area The present study was undertaken in the district of Dir Lower, Khyber Pakhtunkhwa, Pakistan. Dir Lower is situated at a distance of 124 Km away from Peshawar and shares an international boundary with Afghanistan in the west (Fig. 1). It has an area of 1583 Km2 and lies in the lesser Hindukush range between 35°-10′ to 35°-16′ N Latitude and 71°-50′ to 71°-83′ E Longitudes (Khan et al., 2010). The District is bordered by Upper Dir in the north, the district of Swat in the east and Malakand Agency situated towards the south (Champion et al., 1965; Khan et al., 2010). The elevation of this district ranges from 1200 m to 2800 m above sea level and the climate largely depends on altitude (Khan et al., 2010). The district receives its highest rainfall 243.22 mm in March and lowest in July, October, and November. A great diversity of plants is found throughout the district. The present study was conducted in 25 different villages of Dir Lower. 2.2. Field survey The aim of the survey was to record ethnobotanical information from indigenous communities, particularly the ethnic groups in the remote areas. We targeted herbal practitioners and

Fig. 1. Map of study area.

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explained to them the objectives of this study to document the medicinal plants for hypertension in the district. Only those who agreed to volunteer were further interviewed. Permission to conduct our study in each area was obtained from the local elder of the study region. 2.3. Data collection and interviews with local people The ethnopharmacological survey was conducted from November 2012 to December 2013 with individual's native to and still living in the study area. A total of 120 individuals were interviewed in 25 villages (Tangi Shagi, Peto Dara, Rushkhani, Seyar kherky, Chamertaly, Sumerbagh, Versik, Querray Malakand, Bandagi Talash, Shumshikhano Talash, Denda Rabat, Gosam Munda, Kambut Jandhol, Shair Khani Maidan, Balo Khan maidan, Asman Banda Maidan, Larlam Ouch, Morany, Darmal, Lass Khan, Lajbook, Khal, Khongay). We contacted native people and invited those who expressed to have knowledge of local medicinal plants for an interview. All the interviews were conducted in the local language of Pashto during group discussions. Using standard method of Martin (1995) and Cotton (1996), in group discussions and ethnobotanical interviews we asked questions regarding the local name of the plants, medicinal use, parts of the plants used, flowering and fruiting period, the modes of preparation, administration, complete recipes and drug preparation. Most of the local informants interviewed were illiterate with only 7% having a complete college education, 15% a complete high school education and 23% a complete elementary education. Women gave less information when compared to men, and we distributed questionnaires among school students to invite the house women because according to local cultural and societal norms it is not acceptable to directly approach a woman between the ages of 30 and 40. We directly approached and invited men. Most interviewed men were farmers, who had monthly personal cash incomes of 9000 rupees (  $90 USD) or less. 2.4. Plants collection and preservation Medicinal plants were collected from 25 different sites. Regular field trips of the study area were arranged according to the fruiting or flowering season. Whole plants specimens of herbs, ferns and grasses were collected while fruiting or flowering shoots of shrubs and trees were collected. We recorded detailed field notes of the collected specimens number wise i.e. there local name, habit and habitat, locality, date of collection, flower color etc. The collected plants were pressed, dried and mounted on standard herbarium sheets. 2.5. Identification and deposition in herbarium Plants samples were collected in the field and brought to Quaid-i-Azam University in Islamabad where Dr. Mushtaq Ahmad and Dr. Muhammad Zafar identified and compared the plants vouchers specimens in Pakistan Herbarium (ISL) Quaid-i-Azam University Islamabad. After complete identification plants were assigned voucher specimens numbers and deposited as ready reference for future studies. 2.6. Data analysis and documentation The data collected during this study was analyzed and presented in tabulated form using Microsoft Excel. 2.6.1. Use value (UV) UV evaluates the relative importance of each medicinal species

based on its relative use among informants (Gairola et al., 2013). UV was calculated using the following formula Ui UV = ∑ Ni Ui is the number of use reports cited by each informant for a given plant species Ni is the total number of informants interviewed for a given plant species 2.6.2. Relative frequency of citation (RFC) and family importance value (FIV) To quantitatively determine the consensus between the informants on the use of wild medicinal plants in the region we calculated RFC and FIV. It gives the local importance of a species or a family (Kayani et al., 2014; Tardio and Pardo-De-Santayana, 2008). RFC was calculated using the standard method of Vitalini et al. (2013), which is

RFC = FC/N (0 < RFC < 1). FC is the number of informants who mentioned the species N is the total number of informants participating in the study Family importance value calculated using standard method of Kayani et al. (2014), which is FIV ¼ FC /N  100 FC is the number of informants mentioning the family N is the total number of informants participating in the study

3. Results and discussion 3.1. Demographic data of participants In this study, we interviewed a total of 120 local inhabitants using semi-structured questionnaire and group discussions. Of these, the majority of informants belong to the age range of 50–75 years (50.8%) followed by 25–50 age (26.6%) and 75–95 years of age (22.5%). The reason for this may be that most of the local inhabitants who showed interest in traditional knowledge belong to old generation. Gender wise, the majority of informants were male (75%) while female informants were only 25%. The lesser number of female informants was due to cultural norms in the study area. Women are reluctant to talk with people outside of their family. The majority of informants in the study area were illiterate. It was observed that the educated people mostly rely on allopathic drugs instead of using herbal medicines for hypertension (Table 1). 3.2. Medicinal plant diversity and their growth habit In total, 46 medicinal plant species belonging to and 43 genera from 29 families were documented (Table 2). Among dominant plant families, Lamiaceae with 7 species was at top followed by Myrtaceae, Rosaceae and Asteraceae having 3 species (Fig. 2). Family importance value (FIV) ranged from 17.5 to 0.8. In FIV point of view, the most dominant families were: Asparagaceae with FIV followed by Rosaceae, Asclepiadaceae, Fumariaceae, Paeniaceae, Brassicaceae, Amaryllidaceae, Lamiaceae, Apocynaceae and Buxaceae. The lowest values of FIV were observed for Urticaceae followed by Zygophyllaceae, Boraginaceae, Verbenaceae Table 1 Demographic profile of study participants. Informants

Age (25–50)

Age (50–75)

Age(75–95)

Total

Traditional herbalist (male) Male informants Female Informants

11 16 5

16 30 15

3 14 10

30 60 30

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Table 2 Plants and herbal preparation used for treatment of hypertension by the local people of district Dir lower, Pakistan. Scientific name/(voucher no.)

Lamiaceae Ajuga bracteosa Wall. Ex Benth (LA001) Origanum vulgare L. (LA002) Ocimum basilicum L. (LA003) Teucrium stocksianum Boiss (LA004) Mentha longifolia (L.) Huds (LA005) Mentha viridis (L.) L. (LA006) Otostegia limbata (Benth.) Boiss (LA007) Myrtaceae Eucalyptus camaldulensis Dehnh. (LA008) Eucalyptus globulus Dehnh. (LA010) Myrtus communis L. (LA009) Solanaceae Solanum nigrum L. (LA011) Withania somnifera (L.) Dunal (LA012) Asteraceae Artemisia annua L. (LA015) Artemisia vulgaris L. (LA013) Cichorium intybus L. (LA014) Apocynaceae Nerium oleander L. (LA016) Catharanthus roseus (L.) G. Don (LA017) Rosaceae Fragaria nubicola (Hook.f.) Lindl. (LA018) Cotoneaster acuminatus Lindl. (LA019) Rosa brunonii Lindl. (LA020) Umbeliferae Coriandrum sativum L. (LA 021) Foeniculum vulgare Mill. (LA022) Berberidaceae Berberis lyceum Royle (LA023) Paeoniaceae Paeonia emodi Wall. Ex Royle. (LA024) Fumariaceae Fumaria indica (Hausskn.) Pugsley (LA025) Violaceae Viola canescens Wall.Ex (LA026) Buxaceae Sarcococca saligna (D. Don) Muell. Arg. (LA027) Rhamnaceae Ziziphus oxyphylla Edgew (LA028) Urticaceae Urtica dioica L. (LA029) Chenopodiaceae Chenopodium ambrosiodes L. (LA 030) Chenopodium botrys L. (LA031) Zygophyllaceae Tribulus terrestris L. (LA032) Oleaceae Olea ferruginea Royle (LA033) Cuscutaceae Cuscuta reflexa Roxb (LA034) Verbenaceae Verbena officinalis L. (LA035) Euphorbiaceae

Local name Growth form

Status

Part useda

Form of preparations

Dosage

Toxicity (excessive use)

UVb

FCc RFCd

Gooti

Herb

Wild

WP

Decoction

7–2 Days

Body weakness

0.733

18

0.150

Shomaki Kashmali Spairki

Herb Herb Herb

Wild AP Cultivated L Wild WP

Decoction Powder, decoction Powder, decoction

2–3 Weeks 3 Weeks 2 Weeks

None None Body weakness

0.705 15 0.684 08 0.937 22

0.125 0.066 0.183

Enaly

Herb

Wild

10–15

Body weakness

0.812

13

0.108

Podina

Herb

Cultivated AP

Powder, decoction fresh plant extract Powder, decoction fresh plant extract Decoction

7–14 Days

None

0.705 07

0.058

3 Weeks

None

0.666 01

0.008

15–20, Days

None

0.6

01

0.008

15–20, Days

None

0.6

01

0.008

3–4 Weeks

None

0.928

21

0.175

WP

Spin azghay Shrub

Wild

R, L

Lachi

Tree

Cultivated L

Lachi

Tree

Cultivated L

Manno

Shrub

Wild

L

Kermacho

Herb

Wild

L

Ketelal

Herb

Wild

Terkha Terkha Kasni

Shrub Shrub Herb

Wild Wild Wild

Gandairy Sadabahar

Shrub Shrub

Fresh plant extract, dcoction Fresh plant extract, decoction Powder, decoction, paste

1–2 Weeks

None

0.625

13

0.108

R, L

Fresh plant extract, as vegetable Decoction, powder

7–10 Days

May cause jaundice

0.75

16

0.133

L L S, AP

Decoction Powder Powder, decoction

5–10 Days 10–12 2 Weeks

Body weakness None None

0.785 09 0.909 19 0.833 04

0.075 0.158 0.033

Wild L Cultivated L

Decoction Decoction

5–8 Days 8–10 Days

Poisonous effect Poisonous Effect

0.555 06 0.636 03

0.050 0.025

Zamaki toot Herb

Wild

AP

Paste, powder

20–25 Days

None

0.666 02

0.016

Karvarla

Shrub

Wild

R

Powder, decoction

3–4 Weeks

None

0.692

01

0.008

Khwarlch

Shrub

Wild

Fr

Decoction

2–3 Weeks

None

0.833 20

0.166

Dhanya Kaga

Herb Herb

Cultivated Fr Cultivated Fr

Powder, paste Powder, Paste

16–20 2–3 Weeks

None None

0.571 0.70

05 03

0.041 0.025

Qwarray

Shrub

Wild

Rh

Decoction, powder

10–15 Days

Body weakness

0.86

18

0.150

Mamekh

Herb

Wild

Rh

Powder, decoction

12–15 Days

None

0.95

25

0.208

Shatera

Herb

Wild

AP

Fresh plant extract, Powder

2 Weeks

None

0.944 23

0.191

Benafsha

Herb

Wild

AP

Decoction

14–20

None

0.81

07

0.058

Shenolay

Shrub

Wild

L, R

Decoction

3 Weeks

Body weakness

0.947

11

0.091

Eanaly

Shrub

Wild

R

Decoction

3–4 Weeks

None

0.642 01

0.008

Sezonky

Herb

Wild

R, L

Fresh plant extract, decoction

10–15 Days

None

0.714

01

0.008

Sekha

Herb

wild

L

Decoction

20–25

Convulsions

0.625 03

0.025

Kharava

Herb

Wild

AP

Decoction

15–20

None

0.894 06

0.050

Markundi

Herb

Wild

L

Powder, decoction

2–3 Weeks

None

0.75

02

0.016

Khona

Tree

Wild

L

Decoction

15–20 Days

Body weakness

0.812

10

0.083

Akash bil

Herb

Wild

WP

Paste, decoction

2 Weeks

None

0.615

03

0.025

Shomaky

Herb

Wild

L

Decoction

14–20 Days

None

0.571

02

0.016

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Table 2 (continued ) Scientific name/(voucher no.)

Local name Growth form

Status

Part useda

Form of preparations

Dosage

Toxicity (excessive use)

UVb

FCc RFCd

Euphorbia hirta L. (LA036)

Zmaki boty

Wild

WP

Fresh plant extract, decoction

12–15 Days

None

0.647

03

0.025

Asphodelaceae Aloe vera (L.) Burm. (LA037)

Zoqam boty Herb

Cultivated Leaf gel

Paste, decoction

7–10 Days

Decrease blood sugar level

0.733 04

0.033

Shrub

Wild

L

Powder

10–15 Days

None

0.846

11

0.091

Shrub

Wild

YS

Fresh plant extract As vegetable

4 Weeks

None

0.857

23

0.191

Pamenki

Herb

Wild

Ap

Paste, decoction

2–3 Weeks

Body weakness

0.937

22

0.183

Jenjarl

Herb

Wild

Seed

Powder, decoction

12–20 Days

None

0.818

07

0.058

Soor azghay Shrub

Wild

R

Decoction

3–4 Weeks days

None effect

0.47

01

0.008

Zoqam

Herb

Wild

Stem

Paste, decoction

15–20

Poisonous

0.777 03

0.025

Bodi boty

Herb

Wild

AP

Decoction

20–25 Days

None

0.866 06

0.050

Ogaky

Herb

Wild

Bulb

Fresh form

3 Weeks

None

0.882 05

0.041

Guli Nurgas

Herb

Wild

Bulb

Fresh form

15–20 Days

None

0.666 09

0.075

Herb

Araliaceae Hedera nepalensis K. Koch Perwati (LA038) Asparagaceae Asparagus gracilis Royle (LA039) Tendorli Asclepiadaceae Caralluma tuberculata N.E. Brown. (LA040) Brassicaceae Sisymbrium brassiciforme C.A. Mey. (LA041) Celastraceae Maytenus royleanus (Wall. Ex Lawson) (LA042) Cactaceae Opuntia dillenii (Ker Gawl.) Haw (LA043) Boraginceae Onosma hispidum Wall (LA044) Amaryllidaceae Allium jacquemontii Kunth (LA045) Narcissus tazetta L. (LA046) a

Root¼ R, Rhizome ¼Rh, Leaves¼ L, Seed¼ S, Fruit ¼ Fr, Flower ¼Fl, Young shoot¼ YS, Aerial part ¼AP, Whole plant ¼WP, Bulb ¼B. Use value. Frequency of citation (number of informants). d Relative frequency of citation. b c

and Violaceae (Fig. 3). The species which were found to be important in the treatment of Hypertension are: Teucrium stocksianum; Myrtus communis; Rosa brunonii; Paeonia emodi, Fumaria indica; Asparagus gracilis and Caralluma tuberculata. In this study, the life forms documented were herbs, shrubs and trees. Herbs with 63% of total documented plants were most dominant followed by shrubs having 30% of reported plant of present study (Fig. 4). In herbal health care system, herbs are more dominantly used due to their easy accessibility, more healing potential and wide variety of bioactive compounds (Yaseen et al., 2015). It was also revealed in previous studies that herbs have more potential of yielding secondary metabolites, which may be the ultimate source of active compounds responsible for therapeutic actions against diseases. Moreover it was also stated that herbalists use herbs most commonly for herbal formulations due

to their easy collection and availability in nature (Uniyal et al., 2006). 3.3. Parts used and mode of preparations of the medicinal plants In our study, different parts of the plants were used for the treatment of hypertension including aerial parts, roots, leaves, rhizome, young shoots, flower, stems, seed and fruits. The most frequently used plant parts were leaves, followed by aerial parts, root and whole plants (Fig. 5). To best of our knowledge, this is first report from Pakistan about use of leaves in the herbal treatment of hypertension. It was observed in this study leaves are extensively used along with other plant parts. As leaves are one of the main sites for photosynthesis and metabolic center the plant, so this may be the reason for their healing potential in

Lamiaceae Myrtaceae Asteraceae Rosaceae Umbelliferae Amaryllidaceae Solanaceae Apocynaceae Chenopodiaceae Berberidaceae Paeniaceae Fumariaceae Violaceae Buxaceae Rhamnaceae Zygophyllaceae Oleaceae Convolvulaceae Verbenaceae Euphorbiaceae Asphodelaceae Araliaceae Asparagaceae Asclepiadaceae Brassicaceae Celastraceae Cactaceae Boraginaceae Urticaceae

16 14 12 10 8 6 4 2 0

Number of species

Percentage

Fig. 2. Number of plant species in different families and family percentage.

L. Ahmad et al. / Journal of Ethnopharmacology 175 (2015) 138–146

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20 18 16 14 FIV

12 10 8 6 4 2 0

Families Fig. 3. Family importance value (FIV).

In modes of preparation, all of the documented herbal medicines were administered internally through oral application. Frequently used modes of preparations includes decoction, which found to be the most frequent followed by powder, fresh plant extract and paste (Fig. 6). Decoction can often be found as one of the major forms of herbal preparation in traditional herbal medicines because it is easy to prepare by mixing with boiling water (Nadembega et al., 2011). In Pakistan most of the people prefer to use decoction as the route of internal administration (Mehmood et al., 2011). In many cases, plant material is dried and crushed to obtain fine powder. The traditional herbalists mostly sell their recipes at market in powder form. This may be the reason for the frequent use of powder. Sometimes local people add honey, salt, sugar, or banana to increase the palatability of a preparation (Islam et al., 2013).

Tree 7%

Shrubs 30%

Herbs 63%

3.4. Use values (UV) and relative frequency of citation (RFC) Fig. 4. Life form of medicinal plants in the study area. Young shoot 2% Flower 2%

Rhizome Fruit 4% 6%

Seed Bulb 4% 4%

Leaves 38%

Whole plant 10%

Root 12% Aerial part 18%

Fig. 5. Percentage of plant part used for herbal preparation in Dir Lower.

phytotherapies. Various secondary metabolites are produce due to biogenetic pathways, which can give more medicinal value to leaves (Ghorbani, 2005). Moreover, mode of preparations of herbal medicine, ease of collection, drying and crushing may be the factors responsible for frequent use of leaves than other parts of the plant (Telefo et al., 2011). In plant conservation point of view, the frequent use of leaves and aerial parts is sustainable and safe (Giday et al., 2003). The use of the root, fruit or seed for herbal preparation may lead to negative effects on survival of plants in the nature (Ghimire et al., 2008).

The use values are generally used to check the relative importance of single plant species. UV is high for those plants with many use reports (approach to 1) and lowest for those plants with few use reports (approach to 0) as compare to number of informants. In the current study, UV ranged from 0.95 to 0.47. To analyze data, we divided all reported plants in 4 classes on the base of UV. These classes along with number of species and their UV range are: 1st class include 10 species (0.95–0.86); 2nd class 10 species (0.85–0.77); 3rd having 13 species (0.75–0.66); 4th (0.64– 0.47) including 13 species. Among these classes, the plants of 1st class may be regarded as more important than other. These species include: P. emodi, followed by the Sarcococca saligna, F. indica, T. stocksianum, C. tuberculata, Myrtus communes, Artemisia vulgaris, Chenopodium botrys, Onosma hispidum and Berberis lyceum. While the lowest UV was reported for Maytenus royleanus (0.47), Nerium oleander (0.555), followed by the Verbena officinalis (0.571) and Coriandrum sativum (0.571). Plant species with low use values should not be ignored as failing to teach them to upcoming generations could raise the threat of slow vanishing of the knowledge. Plant species having high UV should be further screened in pharmacological studies for valuable compounds present in the plant (Mahmood et al., 2012). To determine quantitatively the most common occurring medicinal plants used for hypertension, relative frequency citation (RFC) was calculated. In present study, the RFC value shows the prominence of medicinal plant species used against hypertension at various localities of the study area. It ranged from 0.2 to 0.008. It was also categorized into 5 classes. 1st class include 5 species (RFC: 0.2–0.17); 2nd class include 8 species (0.166–0.1); 3rd having 12 species (0.09–0.05); 4th classes having 11 species (0.04–0.025) and

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Percentage Decoction

46.66

Powder

24

Fresh plant extract

14.66

Paste

12

As Vegetable

2.66 0

5

10

15

20

25

30

35

40

45

50

Fig. 6. Modes of preparations used for hypertension treatment.

0.25

RFC

0.2 0.15 0.1 0.05 0

Medicinal Plant Species Fig. 7. Relative frequency citations for medicinal plant species.

4th class include 10 species (0.016–0.08). The most important species on the base of RFC are: P. emodi, F. indica, A. gracilis, T. stocksianum, M. communis, C. tuberculata, R. brunonii, A. vulgaris, Ajuga bracteosa and Withania somnifera (Fig. 7). The high values of RFC describes the fact that these medicinal plant species were well known to many number of the local people in the study area (Kayani et al., 2014). The plants having high RFC should be further assessed phytochemically and pharmaceutically to identify their active constituents for drug discovery (Vitalini et al., 2013). In our study many plants have previous ethnobotanical evidences. These plants may be further screened out for drug discovery and development. Like our study, Mahmood et al. (2012) reported that whole plant of Ajuga bractiosa is used for hypertension. Eddouks et al. (2002) reported the aerial parts of plants are found to be effective in hypertension. Tabassum and Ahmad (2011), reported the leaves of Ocimum basilicum are used to treat hypertension. Otostegia limbata was also reported by Haq, (2012) for the treating hypertension. According to Eddouks et al. (2002), M. communes has antihypertensive activities. In our study, this plant is more commonly used. In the study conducted by Jouad et al. (2001) Eucalyptus globulus is reported for hypertension treatment. Fragaria nubicola is mentioned in the study by Camejo-Rodrigues et al. (2003) as anti-hypertensive plant. According to Ara et al. (2009) Catharanthus roseus is used for hypertension treatment and from this study the plant is found to be slightly poisonous, but carefully there leaves are used for hypertension. 3.5. Knowledge against hypertension and status of medicinal plants In the present study, 90.5% of local people showed personal interest about medicinal plants used for the treatment of

hypertension. The local people interviewed from 25 villages believed that Herbal preparations are more effective than allopathic medicines for the treatment of hypertension. We found no or less difference in indigenous knowledge among local people about herbal recipes for hypertension treatment. Furthermore, old people have more information about anti-hypertensive plants than the middle aged people suggesting that this knowledge is going to disappear in the younger generation. The possible main cause may the negligence of indigenous knowledge in new generations (Khuankaew et al., 2013). During the study anti-hypertensive plants were collected in the wild as well as in cultivated form. In our study, 80% of medicinal plants were wild and 20% cultivated. Most wild plants could be easily found on hills and mountains, which show that the present study area is rich in plant diversity allowing for the collection of medicinal plants rather than cultivation. In documented plants, Aloe vera, Foeniculum vulgare and Mentha viridus are cultivated for medicinal purposes while C. sativum is cultivated for spice and condiments. C. roseus is cultivated for ornamental purpose. 3.6. Side and toxic effect of medicinal plants During ethnobotanical interviews, it was also a focus to identify possible side effects of medicinal plants in treating hypertension. In most of the cases the excess use of the herbal drugs is considered to have harmful effects. This is especially evident after the mistaken use of a toxic Aristolochia species by a slimming clinic in Belgium resulting in more than 100 cases of renal failure of which some were fatal (Teng et al., 2006). Understanding the safe use of herbal drugs needs diligent attention. In the study, 32 plants were reported as having no side or toxic effects; 8 plants used as antihypertensive may cause body weakness. Further, it was stated by

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informants that excess use of A. vera may lower blood sugar levels; W. somnifera may cause jaundice and Chenopodium ambrosiodes may cause convulsion. Like our study, in previous studies by Zibbu and Btara (2010) and Kevin et al. (2012) it is mentioned that N. oleander and C. roseus should be used carefully because they are slightly poisonous.

4. Conclusion The present study allowed for collection of information about medicinal plants used for hypertension in the district Dir Lower for the first time. From this study we identified 46 medicinal plant species, which were used by the indigenous people of the study area for the treatment of hypertension. The study provides the basic pathway for future pharmacological and phytochemical investigations of such plants for new, beneficial medicinal properties. To the best of our knowledge, Artemisia vulgiris L., Artemisia annua L., Sisymbrium brassiciforme C. A. Mey., T. stocksianum Boiss, Cichorium intybus L., R. brunonii Lindl., C. botrys L., Olea ferruginea Royle, Cotoneaster acuminatus Lindl, S. saligna (D. Don) Muell. Arg., Viola canescens Wall. ex Roxb, P. emodi Wall. ex Royle, A. gracilis Royle and M. royleanus (Wall. ex Lawson), Allium jacquemontii Kunth, O. hispidum are recorded for the first time as medicinal plants used in treating hypertension. The extensive use of medicinal plants for hypertension reveals local health needs and medicinal plants potential in Dir Lower. The present survey mainly focused on getting information directly from the local people who use such plants for medicinal purposes. The finding of new local names and medicinal uses of the plant in the present survey shows the importance of the documentation of such indigenous knowledge. During ethnobotanical interviews it became very apparent that the younger generation felt shy and showed a lack of interest in plants related questions even though they were current students. While elderly people were pleased when we asked them about medicinal plants and their uses. There is a clear need to document traditional knowledge on medicinal plant usage before it becomes lost to future generations In addition to medicinal plant usage, our study provided insight into the transmission of medical plant knowledge. Irrespective of difference in time since immigration or gender, we found that younger people had less knowledge of medicinal plants than older ones.

Acknowledgment The authors thankfully acknowledges the plant systematics and biodiversity lab. Of Quaid-i-Azam University Islamabad to carry out this research project and also thankful to the local people of the study area for providing relevant ethnomedicinal information.

Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.jep.2015.09.014.

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