Review: Southern African medicinal plants used as blood purifiers

Review: Southern African medicinal plants used as blood purifiers

Journal Pre-proof Review: Southern African medicinal plants used as blood purifiers S. van Vuuren, L. Frank PII: S0378-8741(19)32181-6 DOI: https:/...

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Journal Pre-proof Review: Southern African medicinal plants used as blood purifiers S. van Vuuren, L. Frank PII:

S0378-8741(19)32181-6

DOI:

https://doi.org/10.1016/j.jep.2019.112434

Reference:

JEP 112434

To appear in:

Journal of Ethnopharmacology

Received Date: 30 May 2019 Revised Date:

26 November 2019

Accepted Date: 26 November 2019

Please cite this article as: van Vuuren, S., Frank, L., Review: Southern African medicinal plants used as blood purifiers, Journal of Ethnopharmacology (2020), doi: https://doi.org/10.1016/j.jep.2019.112434. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier B.V.

Review: Southern African medicinal plants used as blood purifiers Blood purifier definition

A historical context

159 Plant species used as traditional remedies for blood purification

Toxicity: e.g. Abrus precatorius, Cissampelos capensis, Datura stramonium, Thesium lineatum etc. Doctrine of signatures and spiritual connection e.g. plants with a red colour used include: Sutherlandia microphylla, Aloe ferox, Leonotis leonurus, Pterocarpus angolensis (bark) etc. The majority of the research output focused on anti-infective investigations (at least 77%).

Review: Southern African medicinal plants used as blood purifiers S. van Vuuren, L. Frank

Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa

ABSTRACT

Ethnopharmalogical relevance: Blood purification practices, also referred to as blood cleansing or detoxification, is an ancient concept which is widespread amongst African traditional medicine, but for which no modern scientific basis exists. There prevails considerable ambiguity in defining what a blood purifier is. Aim of the study: The purpose of this review is to firstly define what a blood purifier is in the context of African traditional medicine and compare to other cultural and westernized interpretations. Thereafter, this study identifies traditionally used medicinal plants used as blood purifiers in southern Africa and correlates these species to scientific studies, which may support evidence for these “blood purifying plant species”. Materials and methods: Ethnobotanical books and review articles were used to identify medicinal plants used for blood purification. Databases such as Scopus, ScienceDirect, PubMed and Google Scholar were used to source scientific articles. An evaluation was made to try correlate traditional use to scientific value of the plant species. Results: One hundred and fifty nine plant species have been documented as traditional remedies for blood purification. Most of the plant species have some pharmacological activity, however, very little link to the traditional use for blood purification. There has been some justification of the link between blood purification and the use as an antimicrobial and this has been explored in many of the plant species identified as blood purifiers. Other pharmacological studies specifically pertaining to the blood require further attention. Conclusion: Irrespective of the ambiguity of interpretation, medicinal plants used to “cleanse the blood”, play an important holistic role in traditional medicine and this review with recommendations for further study provides some value of exploring this theme in the future. *

Corresponding author.

E-mail address: [email protected] (S. van Vuuren). 1

Abbreviations: A, Afrikaans; B, Bushmen; D, Damara; HIV, human immunodeficiency virus; Nd, Ndebele; NSO, northern Sotho; Ky, Kwanyama; P, Pondo; Sh, Shona; Sha, Shangana; Ses, Sesotho; spp, species; TB, tuberculosis; Ts, Tswana; V, Venda; X, Xhosa; Z, Zulu.

Keywords: Blood cleanser; holistic healing; African medicinal plants; blood strengthener; blood impurities; spiritual use; pharmacological activity; antimicrobial.

Contents

1.

Introduction……………………………………………………………………………2

1.1.

Blood purifier definition……………………………………………………………………….2

1.2.

A historical context…………………………………………………………………………….4

1.3.

The westernized context………………………………………………………………………..5

1.4.

The African context ….…………………………………………………………………5

2.

Methods………………………………………………………………………………..6

3.

Overview of the plant species used in blood purification……………………………..7

4.

Toxicity………………………………………………………………………………46

5.

Medicinal use in addition to blood purification ……………………………………..46

6.

Blood

purification

mixtures…………………………………………………………..48 7.

Discussion and future recommendations…………………………………..................49

7.1.

Summary of research undertaken……………………………………………………..……51

7.2.

The link between African blood purification concepts and westernised

principles……52 8.

Concluding remarks………………………………………………………………….52

1.

Introduction

1.1.

Blood purifier definition

Blood purification practices, also referred to as blood cleansing or detoxification, is an ancient concept, which is widespread amongst complementary and alternative medicine 2

ideologies, but for which no modern scientific basis exists (Keville, 1990; Akter et al., 2012). The notion of the origin of disease as an imbalance of normal functioning, be it physiological, psychological or spiritual; humour, chakra, qi or vital force, is deeply embedded in most nonwestern understandings of disease. Related to this is the concept that when the imbalances worsen, so does the severity of symptoms. For example, slight imbalances may present as acne, whereas severe disequilibrium is life threatening. The practice of blood purification therefore offers the opportunity to rebalance the perceived discord in physiological function, whether by lifestyle or herbal intervention, or both, to prevent the progression along the spectrum of symptoms to terminal disease. This may be accompanied by fasting or laxative use (Keville, 1990; Felhaber and Mayeng, 1997). Blood purifiers may also be prescribed routinely in otherwise-healthy individuals as a preventative measure (Akter et al., 2012) or as supportive therapy during convalescence (Felhaber and Mayeng, 1997). What symptoms and conditions warrant treatment with a blood purifier, however, remains vague, with descriptions varying from ‘diseases of the blood’ to a ‘panacea – a remedy for all diseases’ (Gelfand, 1985), as well as ambiguity of when blood purifiers may be prescribed - prophylactically, during active disease or to assist recovery after disease. Nonetheless, the varied medical conditions for which a blood purifier may be prescribed include a range of diseases from mild complaints (acne) to more serious diseases (e.g. diabetes) (Table 1). In addition, blood purifiers have claimed to be beneficial for allergies, body odour, cancer and accumulation of toxins (https://www.webnat.com/articles/BloodPurifiers.asp; https://jonbarron.org/blood-cleansing/cleansing-your-blood). ‘Impure’ or ‘dirty blood’ arises predominantly from the idea that toxins accumulate in the blood, which eventually overwhelm the normal homeostatic mechanisms of the body. Toxins are implied to be unnatural or foreign substances that are the result of a modern lifestyle e.g. wrong eating habits or bad food, inclusion of preservatives or colorants in food, household chemicals, airborne pollutants, products of stress etc. (Felhaber and Mayeng, 1997; Akter et al., 2012; Chauhan, 2013). Keville (1990), mentions that the waste products of an immune response also fall under the category of toxins and Akter et al. (2012) notes that toxins may arise from undigested material or sluggish bowel movements. The unrestrained accumulation of toxins and resulting imbalance is then believed to poison the body and compromise the immune system, resulting in a broad range of ailments as observed in Table 1 (Gelfand, 1985; Keville, 1990; Hutchings, 1996; Akter et al., 2012; Chauhan, 2013). Blood purifiers are said to facilitate the elimination of toxins by stimulating the liver, kidney or lymphatic system, by 3

neutralization in the blood or by providing nutrients to optimize blood function (Keville, 1990; Akter et al., 2012). Table 1 Medical conditions linked to the need for a blood purifier.

Medical condition Reference Acne, abscesses, pimples and other Watt and Breyer-Brandwijk, 1962; Naveen, 2011; Shankar, 2011; Chauhan, 2013 skin complaints Acharya et al., 2011; Shankar, 2011; Olivier, 2012 Anemia Chauhan, 2013 Bad circulation Akter et al., 2012; Chauhan, 2013 Constipation Shankar, 2011 Diabetes and or hyperglycemia Shankar, 2011; Chauhan, 2013 Eye sight (weakened) Chauhan, 2013 Hair loss Chauhan, 2013 Headaches Keville, 1990; Chauhan, 2013 Immune system (weakened) Rimmelé and Kellum, 2011; Shankar, 2011; Infections Olivier, 2012; Aniys, 2016 Shankar, 2011; Chauhan, 2013 Inflammation Acharya et al., 2011; Shankar, 2011 Jaundice and liver ailments Olivier, 2012; Chauhan, 2013 Low and high blood pressure Rimmelé and Kellum, 2011 Rashes Chauhan, 2013 Sepsis Akter et al., 2012 Spleen (enlargement) Watt and Breyer-Brandwijk, 196) Stomach ache Aniys, 2016 Toxins in the blood Wrong eating habits Wrinkles on the face 1.2.

Felhaber and Mayeng, 1997 Chauhan, 2013

A historical context

Blood purification in various forms have been practised since antiquity. In ancient times and right up until the 19th century, medical practitioners believed that illness was merely the result of “bad blood.” As such, bloodletting (the release of blood via an incision) was commonly practised. Physicians like Hippocrates and Galen maintained that the human body was filled with four basic “humors” (yellow bile, black bile, phlegm and blood) which needed to be kept in balance to maintain proper health. With this in mind, patients with a fever or other ailments were often diagnosed with an overabundance of blood. To restore bodily harmony, the doctor would simply cut open a vein and drain some blood from the 4

patient. Often, leeches were used to aid in the rapid removal of blood. According to Ayurveda, the leech at first bite only sucks impure blood from the skin and only the pure blood is left, thus supporting the blood purification therapy claims. Another method of blood release, for the purpose of holistic healing, is evident in the Ebers Papyrus, written c. 1550 BC which is one of the oldest medical textbooks in the Western world. Here it is described how the Egyptians use cupping. This method involves first, using a pricking needle, and then a cup is applied over the site to release the blood (Mehta and Dhapte, 2015).

1.3.

The westernized context

In allopathic medicine, blood purification is an extracorporeal intervention employed in cases of advanced kidney, liver, heart and other immune-inflammatory disease states such as sepsis. Blood is circulated through an external device where toxins are removed and the purified blood is subsequently returned to the patient (Peng et al., 2010). Blood purification for the treatment of sepsis is defined as the ‘non-specific removal of a broad-spectrum of inflammatory mediators, which may include microbial toxins’ (Rimmelé and Kellum, 2011). Examples of blood purification techniques include haemoadsorption, haemodialysis, haemofiltration, haemoperfusion and plasma exchange (Zhou et al., 2013). The return to physiologic homeostasis is associated with better clinical outcomes (Zhou et al., 2013) and is thought to ‘restore immune function by improving antigen-presenting capability, adjusting leukocyte recruitment, oxidative burst and phagocytosis, and improving leukocyte responsiveness’ (Peng et al., 2010). Blood purification has been used extensively in peritoneal dialysis, for renal replacement therapy and hepatic failure (Thongboonkerd, 2010) While the westernised concept of blood purification remains firmly grounded in techniques to remove pathogenic substance or toxic substance from the patient's blood, the methods used have become extremely advanced leading to technologies using polymers, resins and nanoparticles (Ju et al., 2019).

1.4.

The African context

Blood is a sacred element in the African tradition (Takyi, 2013), and forms part of many cultural traditions. There is the belief that illness is not just derived from chance occurrences, but through spiritual or social imbalance and thus blood purification may offer a holistic healing. 5

From an African perspective, blood purifying treatment is given in the form of herbal medicines (Keville, 1990; Olivier, 2012). There is a strong correlation between the use of medicinal plants as a tonic and as a blood purifier (Olivier, 2012). There is a vague distinction between general herbal tonics which are intended to ‘strengthen the blood’, whereas blood purifiers are intended to ‘cleanse the blood’, and although the outcome of increased energy and speedy recovery may be the same, a tonic does not automatically confer blood purifying properties. It is perhaps because of this ambiguity that herbal blood purifier use is so widespread in African traditional medicine (and worldwide). According to Olivier (2012), blood purifiers may also be affiliated to alteratives. While there have been a number of documented reports (for example White, 2013; Ngcobo et al., 2017; WHO, https://www.afro.who.int/health-topics/traditional-medicine; Ozioma and Chinwe, 2019) which delve into the holistic definition of African traditional medicine, there has been no conservative effort to define and investigate the possible role of South African medicinal plants used for blood purification. There is no doubt that a holistic approach to African traditional healing is key with a strong influence of spiritual connection. We hope with this publication to explore the possible pharmacological effects and connect this to the documented plant species can stimulate interest in research this field of blood purification and in doing so, provide a pathway for a more detailed definition.

2.

Methods

In spite of the ambiguity of the use of blood purifiers in African holistic medicine, it is quite clear that African medicinal plants are frequently used to “cleanse the blood” The purpose of this review was to document southern African medicinal plants explicitly listed as blood purifiers. For the purposes of traditional use, the terms “blood purifier, blood cleanser, blood strengthener or blood impurities” were used to search in relevant ethnomedical books and ethnobotanical reviews. Exclusion criteria were terms related to a tonic as this had no direct correlation to the blood. The medical terms “blood clotting, blood in the stool, blood, disorders, blood pressure and blood thinners” were also excluded as these denoted treatments relating to specific blood diseases. Only plant species where both genus and species were documented were included. The review also examines the supportive evidence for potential medical application of these plant species to discern if generalisations can be made about

6

blood purifying potential. Data bases such as Scopus, ScienceDirect, PubMed and Google Scholar were used to source scientific articles.

3.

Overview of the plant species used in blood purification

Table 2 provides a breakdown of species identified as blood purifiers in southern Africa obtained from authoritative reference texts. The plant species identified in Table 2 belong to 65 families. The family with the most plants identified for blood purification was Asteraceae with 13 species, followed by Asphodelaceae with 11 species and thereafter Fabaceae with 10 species (Table 3). It was found that in certain cases multiple (from two up until four) species from the same genus were used for blood purification (Table 4). The Aloe species for example is the most frequently mentioned genus. Interestingly, the Aloe species has a well-documented ethnobotanical history with respect to use as a laxative (Chen et al., 2012). Blood purification in the African context is strongly associated with colon cleansing and purging. In fact, a number of African commercial products “Blood mixture Umuthi weGazi Moriana waMadi”, “Idhliso Sejesco mixture” and “Skin and blood mixture” (African Medicines) list Aloes as their main ingredient for blood purification. Various parts of the plant were used as blood purifiers. The most frequently used plant part was the underground parts including roots, bulbs and tubers (39%) (Fig. 1). This is not surprising as the African context often associates treatments with plant parts. As blood forms part of the internal body and is thus hidden, so too does the root structure which is below ground and hence a correlation to the doctrine of signature concept. The doctrine of signatures is an ancient herbal concept. The philosophy dates back to the ancient physicians Dioscurides (circa 40-90 AD) and Galen (circa 129-200 AD) who stated that herbs with similarity in shape or colour to various parts of the body could be used to treat ailments of those body parts (Efferth and Greten, 2016). The frequent use of roots as a blood purifier falls within this doctrine. Also, there is a pharmacognostical precept which exists in the San and Sotho culture, where plant parts or extracts with red colours are thought to treat ailments pertaining to the blood, such as anaemia, weakness (to ‘strengthen the blood’) and fever. Within this context, some plants with a red colour used as blood purifiers include Sutherlandia microphylla, Aloe ferox, Leonotis leonurus and Kniphofia caulescens (flowers), Abrus precatorius (seeds), Harpephyllum caffrum, Chironia baccifera and Pterocelastrus rostratus (berries), and Elephantorrhiza elephantina and Pterocarpus angolensis (bark). Of particular interest is the medium to large sized deciduous tree P. angolensis. Amongst the 7

numerous medicinal (earache, menorrhagia, infertility, sore eyes, diarrhoea, nose bleeding, headache, stomachache, schistosomiasis, sores and skin problems) and general uses (furniture, carvings, dishes, drums and indigenous timbers), is the link to blood.

8

Table 2 Southern African plants used as blood purifiers. Species

Family

Some vernacular names Lucky bean, munhutavaroi (Sh), umabophe (Nd)

Main uses

Abrus precatorius L.

Fabaceae

Acacia caffra (Thunb.) P.J.H.Hurter & Mabb.

Fabaceae

Red thorn, rooibas/doring (A), umkhamanzi (Z)

Acacia chariessa Milne - Redh.

Fabaceae

Ulutatau (Nd)

Acokanthera oppositifolia (Lam.) Codd Albizia adianthifolia (Schumach.) W.Wight)

Apocynaceae

Slangblar (A)

Fabaceae

Flat-crown tree, platkroondoringboo m (A), muvhadangoma (V), Umhlandlothi (X),

Bark (infusion): blood cleansing emetic Milk and leaf (infusion): infantile colic Root: charm (Hutchings, 1996; Venter and Venter, 1996) Root (infusion): blood purification, prevent infectious disease in new-borns (Gelfand, 1985) Foliage: constipation, cleans the stomach, blood purifier (Philander, 2011) Bark: used in Zulu medicine for cleansing of blood, skin diseases and scabies, bronchitis, in love charms, as emetics and as enemas administered to pregnant women

Leaves (infusion): haematemesis, blood purification Root (infusion): infertility Seed: charm to remain young or lucky (Gelfand, 1985)

Some related studies on pharmacological activity Numerous biological studies - review (Garaniya and Bapodra, 2014) Antibacterial (Janakiraman et al., 2014) Antimycobacterial (Ibekwe et al., 2014) and anti-inflammatory (Madikizela et al., 2014) Anti-oxidant (Jain et al., 2015) Antitrypanosomal (Hata et al., 2014) Larvicidal (Adebajo et al., 2014) Antifungal (Masevhe et al., 2015)

No relevant research

Anthelmintics (Aremu et al., 2010) prostaglandin-synthesis inhibitors (Jäger et al., 1996) Antimicrobial (Tchinda et al., 2017) Anticancer activity (Noté et al., 2018)

9

Species

Family

Some vernacular names umgadankawu (Z)

Albuca bracteata (Thunb.) J.C.

Hyacinthaceae

Albuca flaccida Jacq

Hyacinthaceae

Umababaza, Imbabazane, Unsunsu Inqwebeba (Z, X)

Aloe arborescens Mill.

Asphodelaceae

Aalwyn (A)

Aloe ferox Mill.

Asphodelaceae

Aloe, bitteraalwyn (A), winkelaalwyn (A)

Main uses To clear their urine. Powdered bark is also used as a snuff for headaches and sinusitis. Stem bark is used for epilepsy, gonorrhoea and eyesight problems (Watt and Breyer-Brandwijk, 1962; Pujol, 1990; Hutchings, 1996; van Wyk et al., 1997; Grace et al., 2003; van Wyk et al., 2009; Corrigan et al., 2011) blood purification, dermatologial (wounds), tonics (imbiza) (Mhlongo and van Wyk, 2019) Bulbs: blood purifier, cholesterol, hypertension, cancer, ulcers, cleans the womb and blood in the stomach purifier (Philander, 2011) Foliage: blood purifier, gastrointestinal complaints, skin ailments, acne Crystallized aloe sap: diabetes purifier (Philander, 2011) Diabetes, stomach ailments, constipation, treatment of retained placenta, blood purifier, wounds and sores (Nortje and van Wyk, 2015)

Some related studies on pharmacological activity

Anti-inflammatory activity (Odeyemi and Afolayan, 2015) Anti-oxidant (Odeyemi et al., 2017) No relevant research

Numerous biological studies - review (Amoo et al., 2014) Male reproductive protection (Solek et al., 2018) Numerous biological studies - review (Chen et al., 2012) Diabetes (El Sayed et al., 2016) Acne (Jeong and Kim, 2017) Skin and wound healing (Coopoosamy and Naidoo, 2013; Finberg et al., 2015; Ghuman et al., 2016; Fox et al., 2017) 10

Species

Family

Aloe greatheadii Glen & D.S. Hardy

Asphodelaceae

Aloe striatula Mill. Aloe zebrina Baker

Asphodelaceae

Amaranthus thunbergii Moq. Anchusa capensis Thunb.

Amaranthaceae

Annona senegalensis Pers.

Annonaceae

Asphodelaceae

Boraginaceae

Some vernacular names Ihlaba (X), ikala (X), ikalana (X), umhlaba (X)

Hardy aloe, coral aloe Ihlaba (X), ikala (X), Ikalana (X), umhlaba (X) Thunberg's pigweed Cape-forget-menot, vergeetmynietjie (A), ystergras (A), koringblom (A), ossetongblaar (A), petlekheme (Ses) Wild custard apple, muroro (Sh), ububese (Nd)

Main uses Leaf sap: skin irritations, bruises, burns. Leaves, roots and whole plants: general ailments, blood cleansing, internal parasites, eye infections (van Wyk et al., 1997; van der Merwe et al., 2001) blood purifier (Moffett, 2010) Whole plant: burns, general ailments, blood cleansing, internal parasites, eye infections (van der Merwe et al., 2001) blood purifier (Moffett, 2010) blood purifier (Moffett, 2010), inflammation (http://pza.sanbi.org/anchusacapensis)

Root (infusion): abdominal pains, hiccoughs, lucky charm, oedema, antiemetic, constipation, boils, sprains, snake repellent, syphilis, gonorrhoea, bloody in diarrhoea, dysmenorrhea, menorrhagia Root and bark: chest pain, blood purification (Gelfand, 1985)

Some related studies on pharmacological activity Numerous biological studies – review (Amoo et al., 2014)

Antibacterial and anticancer (Bisi-Johnson et al., 2011) Review (Amoo et al., 2014)

No relevant research on human illnesses but more reference to nutritional value as a food No relevant research

Antibacterial (Magassouba et al., 2007; Okoye et al., 2012) Antibacterial and antifungal (More et al., 2008) Anticonvulsant, central antidepressant and anxiolytic (Okoli et al., 2010) Antidiarrheal (Suleiman et al., 2008) Antidrepanocytary (Mpiana et al., 2007) Anthelminthic (Alawa et al., 2003; Fall et al., 11

Species

Family

Some vernacular names

Main uses

Annona stenophylla Engl. & Diels.

Annonaceae

Dwarf custard apple, muroro (Sh), ububese (Nd)

Antizoma angustifolia Miers. ex Harv.

Menispermaceae

Maag-bitterwortel (A)

Arctopus echinatus L.

Apiaceae

Platdoring (A), pokkiesdoring (A), poxthorn, sieketroos (A)

Blood purifier (Gelfand, 1985) Roots: paste applied on the boils; extract drunk as chest pains and STI remedy (Maroyi, 2013) Root: intestinal troubles, blood purifier, boils, syphilis, snakebite, emetic and purgative, emetic and purgative action, kidney stones, bladder problems Leaf: wounds, bladder ailments, glandular swellings. A tincture is used for diarrhoea, colic and cholera (Watt and BreyerBrandwijk, 1962; Rood, 1994) bladder ailments, purgative, diuretic, skin irritations, blood purifier related to sexually transmitted infections (STI), syphilis, gonorrhoea (Watt and Breyer-Brandwijk, 1962; Magee

Some related studies on pharmacological activity 2008) Antimalarial (Fall et al., 2003; Ajaiyeoba et al., 2006) Anti-oxidant and drug detoxification (Ajboye et al., 2010) Antitumour (Durodola, 1975) Antitrypanosomal (Freiburghaus et al., 1996; Ogbadoyi et al., 2007; Kabiru et al., 2010) Antivenom (Emmanuel et al., 2014) Cytotoxic (Ahmed et al., 2010) Anti-oxidant activity (Munodawafa et al., 2010)

Acaricidal activity (Fouche et al., 2016)

Antimicrobial (Magee et al., 2007)

12

Species

Family

Some vernacular names

Artemisia afra Jacq. ex Willd.

Asteraceae

Wild wormwood, wilde-als (A)

Athrixia phylicoides DC.

Asteraceae

Bushman's tea, boesmanstee (A), icholocholo (Z)

Asparagus capensis L. var. capensis Asparagus stipulacea Lam.

Asparagaceae

Katdoring (A)

Asparagaceae

Katdoring (A) imvane (X)

Berkheya setifera DC.

Asteraceae

Buffalo-tongue thistle, Ikhakhasi (Z), Indlebelenkomo (X), Lelelemla-khomo

Main uses et al., 2007) Leaf (compress, decoction, tea): wounds, toothache, haemorrhoids, respiratory complaints, colic, heartburn, eye complaints, neuralgia, rheumatism, blood purification, diabetes, worms, blood poisoning (Watt and Breyer-Brandwijk, 1962; von Koenen, 1996), purifier (Philander, 2011)

Root (decoction): cough, purgative; Whole plant (infusion): blood purifier for sores and (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Root: blood purifier, hypertension (Philander, 2011) blood purifier, tuberculosis (TB), emetic, diuretic (Watt and BreyerBrandwijk, 1962; van Wyk, 2008) Leaves (decoction): pustular ophthalmic Root (decoction, infusion): urinary complaints, blood purifier

Some related studies on pharmacological activity Numerous biological studies - review (Liu et al., 2009) Anticancer (Spies et al., 2013) Antidiabetic (Afolayan and Sunmonu, 2011, 2013; Sunmonu and Afolayan, 2013) Antimicrobial (Buwa and Afolayan, 2009; Suliman et al., 2010; More et al., 2012) Masoko (Masoko and Nxumalo, 2013) Anti-oxidant (Sunmonu and Afolayan, 2012) Bronchodilatory (Mjiqiza et al., 2013) Hyperpigmentation (Lall and Kishore, 2014) Sedative (Stafford et al., 2005) Numerous biological studies - review (Joubert et al., 2008; McGaw et al., 2013) Antimicrobial (Tshivhandekano et al., 2014)

No relevant research

No relevant research

Antischistosomic (Sparg et al., 2000)

13

Species

Family

Some vernacular names (SS), Ntsoantsane (SS), Rasperdissel (A) Glossy bersama, blinkblaarwitessenhout (A), isindiyandiya (X), undiyaza (Z)

Main uses Roots and leaves (topical): rheumatism, sores (Hutchings, 1996) Use according to traders, strengthens the blood (Khumalo, 2018)

Bersama lucens (Hochst.) Szyszył.

Melianthaceae

Bidens pilosa L.

Compositae

Marigold, umhlabangubo (X)

Blood purifier removes toxins from the body (Asowata-Ayodele et al., 2016)

Bowiea volubilis Harv. Ex Hook. F. subsp. volubilis

Asparagaceae

Climbing onion, iguleni (Z)

Bridelia micrantha (Hochst.) Baill.

Phyllanthaceae

Umhlahlandlela, Umhlalamakhwabe, Umluthu (Z)

Bulbine alooides Willd.

Asphodelaceae

Rooi wortel (A)

Bulbine latifolia (L.f.) Spreng. Var. latifolia

Asphodelaceae

Red carrot, rooiwortel (A)

Bulb: headache, sore eyes, backache, muscle pain, bladder infections, increases fertility, purifies blood, emetic, love charm, reduces swelling (Philander, 2011) Blood purifier, gastrointestinal (heartburn), respiratory infections (coughs), tonic, trauma (Mhlongo and van Wyk, 2019) Blood purifying, rheumatism, (Smith, 1895; Watt and BreyerBrandwijk, 1962; van Wyk, 2008) Root: erectile dysfunction; kidney and bladder problems, STI’s, womb and prostrate problems, arthritis, cancer, hypertension, diabetes; osteoporosis, blood

Some related studies on pharmacological activity

Antimicrobial activity (Buwa and van Staden, 2006)

Anti-oxidant and immunomodulatory activity (Abajo et al., 2004) Antidiabetic (Hsu et al., 2009) Anticancer (Shen et al., 2018) Numerous biological studies - review (Aremu et al., 2015)

Anti-oxidant (Nwaehujor and Udeh, 2011) Anticonvulsant and sedative effects (Bum et al., 2012) Anti-diarrhoeal (Lin et al., 2002) Other pharmacological activities but not as specified under main uses Anti-inflammatory (Jäger et al., 1996) Antibacterial, anthelmintic and anti-amoebic activity (McGaw et al., 2000)

14

Species

Family

Bulbine Narcissifolia Salm-Dyck

Asphodelaceae

Burchellia bubalina (L.f.) Sims Callilepis leptophylla Harv.

Rubiaceae

Capparis tomentosa Lam.

Capparaceae

Catharanthus roseus (L.) G.Don

Apocynaceae

Cephalaria zeyheriana Szabó

Caprifoliaceae

Asteraceae

Some vernacular names

Main uses

purifier, promotes fertility (Philander, 2011) Khomoeabalisa Stomach ailments, diabetes, (Ba, Ses) infertility, cleans impurities in blood (Kose et al., 2015; Mugomeri et al, 2016) Utshwala benyoni Blood purifier, impotence, as a (Z) tonic (Mhlongo and van Wyk, 2019) Pila (Manyika) Cough, fever, "bad blood", tonic (Watt and Breyer-Brandwijk, 1962) Woolly caperbush, Rootbark (decoction): blood wollerige kapperbos purifying enema, scrofula, cough (A), umqoqolo (Z) expectorant, prevent abortion, apoplexy, malaria, jaundice, headache, charms (Hutchings, 1996) Periwinkle, vinca, Flowers (infusion): blood ikhwinini (Z) cleansing; Sap: insect bites, warts Whole plant: gonorrhoea (Hutchings, 1996)

Uzondle (Z)

Root (decoction): blood purifier against syphilis, unaccountable swelling and pains, TB (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996)

Some related studies on pharmacological activity

Other pharmacological activities but not as specified under main uses

Antibacterial, antifungal and antiinflammatory activity (Amoo et al., 2009) No relevant research

Antibacterial (Steenkamp et al., 2004) Antimalarial (insecticidal) (Chalannavar et al., 2013) Antiplasmodial (Bapela et al., 2014)

Antibacterial (Akinnibosun and A, 2011; Govindasamy and Srinivasan, 2012) Antidiabetic (Ojewole and Adewunmi, 2000) and anti-oxidant (van de Venter et al., 2008; Tiong et al., 2013; Tiong et al., 2015) Antineoplastic (Shams et al., 2009; El-Seedi et al., 2013) No relevant research

15

Species

Family

Chamaesyce inaequilatera (Sond.) Soják

Euphorbiaceae

Chenopodiaceae Chenopodium album L. Chironia baccifera Gentianaceae L.

Some vernacular names Smooth creeping milkweed, gladdekruipmelkkru id (A), otjiwta (H) Fat hen, misbossie (A), isijanabe (Z) Wild gentian, Christmas berry aambeibos (A), tand-pyn-bossie (A) ag-dae-genees-bos (A, ), perdebossie (A), bitterbos (A) Brother berry, boetabossie (A), umtholombi (Z)

Chrysanthemoides monilifera (L.) Norlindh

Asteraceae

Citru limon (L.)Burm.F. Cissampelos capensis L.

Rutaceae

Lemon

Menispermaceae

Gifhondjie (A), ≠gans≠gani (B) dawidjie (A)

Main uses Latex: contracts wound edges Leaves (tea): blood purifier, labour Whole plant: baby powder, skin rashes (von Koenen, 1996) Cooked vegetable: blood purifier (Hutchings, 1996) Sores, a decoction of the whole plant is taken as a blood purifier, skin eruptions such as acne, heatrash, veld sores, boils, sexually transmitted infections, purgative (Watt and Breyer-Brandwijk, 1962) Fruit juice: blood strengthener and purifier to men suffering from impotence or weakened by intestinal ailments, acne Leaves (infusion): enema for fever (Hutchings, 1996) Blood cleanser, diuretic (Asowata-Ayodele et al., 2016) Root (decoction): menstrual complaints, expulsion of placenta, blood purifier, erypsipelas, furuncles, venereal disease, snake bite, wound healing, diarrhoea, general malaise, stomach, high blood pressure, gastroenteritis, to purify blood, rashes (Smith,

Some related studies on pharmacological activity No relevant research

Anti-arthritic (Arora et al., 2014) Nutritional (Afolayan and Jimoh, 2009) Antimicrobial (Thring et al., 2007)

No pharmacological activity

Numerous health benefits but none relating to the use as a blood purifier. Sperm capacitation (Shalaweh et al., 2015)

16

Species

Family

Some vernacular names

Main uses

Some related studies on pharmacological activity

1895; von Koenen, 1996; van Wyk et al., 2009)

Clausena anisata (Willd.) Hook.f. ex Benth.

Rutaceae

Horsewood, perdeboom (A)

Leaves (decoction): rheumatism, fevers, deodorant, blood strengthener and purifier Roots and leaves (infusion): parasiticide Root (decoction): heart ailments, halitosis from liver complaints (Hutchings, 1996)

Clutia natalensis Bernh.

Euphorbiaceae

Umbezo (X)

Combretum

Combretaceae

Large-fruited

Blood purifier (Moffett, 2010) Leaf: indigestion (Watt and Breyer-Brandwijk, 1962) Leaves (ointment, extract,

Antibacterial and cytotoxic (Tatsimo et al., 2015) Anticonvulsant (Makanju, 1983; Kenechukwu et al., 2012) Antidiabetic (Ojewole, 2002) Antifungal (Hamza et al., 2006) Antihelminthic (McGaw et al., 2000) Antihypertensive (Duncan et al., 1999) Anti-inflammatory (Adebayo et al., 2015) Antimalarial and analgesic (Okokon et al., 2012) Antimicrobial (Senthilkumar and Venkatesalu, 2009; Osei-Safo et al., 2010; Agyepong et al., 2014; Christensen et al., 2015; Lawal et al., 2015a) Anti-oxidant (Lawal et al., 2015b) Insect repellent (Innocent and Hassanali, 2015) Larvicidal (Govindarajan, 2010; Mavundza et al., 2013; Jayaraman et al., 2015; Mukandiwa et al., 2015) No pharmacological activity on this particular species Analgesic (Lindsey et al., 1998) 17

Species

Family

zeyheri Sond.

Some vernacular names bushwillow, raasblaar (A), omusheshe (Ky)

Croton sylvaticus Hochst.

Euphorbiaceae

Umahlabekufeni), Umgweba, Umzilanyoni (Z)

Crinium moorei Hook. f.

Amaryllidaceae

Natal lily, umduze (Z)

Curtisia dentata (Burm.f.) C.A.Sm.

Curtisiaceae

Assegai-tree, assegai (A), mufhefhera (V), umgxina (X), umlahlen’ usefile (Z)

Cucurbita pepo L

Cucurbitaceae

Cussonia paniculata Eckl. & Zeyh.

Araliaceae

Pumpkin, imithwane (X), Mots’et’se (B)

Cymbopogon validus (Stapf) Stapf ex Burtt

Poaceae

Gaint Turpentine grass, isiqunga (Z)

Main uses decoction): backache, eye complaints Roots (decoction): scorpion stings, haemorrhoids, blood purifier, leprosy, cough, diarrhoea (von Koenen, 1996) Toothache, sharp internal body pains, blood purification, stroke (Mhlongo and van Wyk, 2019)

Some related studies on pharmacological activity Anticandidial (Runyoro et al., 2013) Antimicrobial (Fyhrquist et al., 2002)

Varied pharmacological activity – review (Maroyi, 2017)

Root (decoction): blood purifier for scrofula, urinary complaints, pain in rheumatic fever (Hutchings, 1996) Bark: used for a bleeding stomach, diarrhea and to strengthen the blood. Also for diarrhoea, for acne, and as a skin lightening ingredient (Pujol, 1990; (Hutchings, 1996; Grace et al., 2003; van Wyk et al., 2009) To treat arthritis, blood booster (Asowata-Ayodele et al., 2016) Powdered bark boiled and used to clean blood (Mugomeri et al., 2016)

Acetylcholinesterase inhibitory and antioxidant (Adewusi and Steenkamp, 2011) Anti-inflammatory (Fawole et al., 2010) Neuroprotection (Seoposengwe et al., 2013) Antimicrobial (Shai et al., 2009; Doughari et al., 2012; Fadipe et al., 2015; Mongalo et al., 2016) Anti-oxidant (Doughari et al., 2012)

Colds, protective charms, strengthen blood, used for emetics and enemas and to,

Anti-inflammatory (Rungqu et al., 2016)

Numerous health benefits - review (Montesano et al., 2018) Anticancer (Fouche et al., 2008) Antimicrobial (de Villiers et al., 2010)

18

Species

Family

Some vernacular names

Main uses

Some related studies on pharmacological activity

stimulate milk for breastfeeding (Pujol, 1990)

Davy

Cynodon dactylon (L.) Pers.

Poaceae

Dog's tooth, kweekgras (A), omguena (Ky)

Datura stramonium L. Dianthus basuticus Burtt Davy

Solanaceae

Ekebergia capensis Sparrm.

Meliaceae

Umhlamvuthwa Lechoe Lesotho carnation, Drakensberg carnation, Lesothose grootblom-wilde angelier (A) Cape ash, essenhout Bark (poultice,infusion): blood (A), umathunzini purifier for boils, abscesses and (Z) pimples Bark or root (decoction): heartburn, chronic cough Leaves (infusion): parasiticide (Hutchings, 1996)

Caryophyllaceae

Whole plant (decoction): swellings, sores, diuretic, wounds, digestion, blood purifier Root: indigestion, swelling, blood purifier (Watt and BreyerBrandwijk, 1962; von Koenen, 1996; Moffett, 2010) Roots and leaves: blood purifier (Komoreng et al., 2017) Blood purifier (Moffett, 2010), diabetes, as an immune modulator (Moteetee and van Wyk, 2011)

Angiogenic (Soraya et al., 2015)

Numerous biological studies - review (Gaire and Subedi, 2013) Anti-oxidant and antidiabetic activities (Kazeem and Ashafa, 2015)

Antihypertensive (Kamadyaapa et al., 2009) Anti-inflammatory (Mulaudzi et al., 2013) Antimicrobial (Mulaudzi et al., 2011) Antimycobacterial (Lall and Meyer, 1999) Antiplasmodial (Muregi et al., 2004; Koch et al., 2005; Muregi et al., 2007a; Muregi et al., 2007b; Murata et al., 2008) Cytotoxic (Irungu et al., 2014) Uterotonic (Sewram et al., 1998; Sewram et al., 2000)

19

Species

Family

Some vernacular names Common saffron, gewone saffraan (A), umbovane (X), isithundu (Z)

Main uses

Elaeodendron croceum (Thunb.) DC.

Celastraceae

Elephantorrhiza elephantina (Burch.) Skeels

Fabaceae

Mositsane (Ba, Ses, Ts), elandsboontjie (A), looiersbossie (A), umdabu (Z)

Eragrostis curvula (Schrad.) Nees

Poaceae

Weeping lovegrass, seritsoana (Ses, Ba)

Euclea natalensis A. DC.

Ebenaceae

Bergghwarrie (A), indungamuzi (Z) isiNzimane (X), inKhunzana (X), uManyathi (X), chikisami (X)

Bark: urinary tract infections, STI, sores, schistosomiasis. Root (decoction): scofula, blood purifier, stomach disorders, dysmenorrhea, abnormal growths (Hutchings, 1996; Corrigan et al., 2011)

Eucomis autumnalis (Mill.)

Hyacinthaceae

Ukhwali, Umathunga (Z)

Sharp internal body pains, back and general body pains, sexually

Uses according to traders include the bark which is used as an emetic to clean the blood (Khumalo, 2018) Stomach and intestinal disorders, breast cancer, infertility, syphilis, TB, herpes, piles, abdominal pains, cleans blood Root: diarrhoea, dysentery, used for " bad blood", heart disease, miscarriage, fever (Watt and Breyer-Brandwijk, 1962; Moffett, 2010; Kose et al., 2015) Stomach ailments, cleans blood, TB (Kose et al., 2015)

Some related studies on pharmacological activity Antimicrobial activity (Mamba et al., 2016; Elisha et al., 2017) Anti-oxidant and in vitro anti-inflammatory activity (Mamba et al., 2016; Odeyemi and Afolayan, 2017) Antidiarrhoeal activities (Mathabe et al., 2006; Mpofu et al., 2014; Saheed and Tom, 2017)

Anti-oxidant and neuroprotective activity (Na et al., 2017) Anticancer (Kishore et al., 2014) Antifungal (Lall et al., 2006; van Vuuren and Naidoo, 2010) Antimicrobial (Stander and van Wyk, 1991; Weigenand et al., 2004; More et al., 2008) Antimycobacterial (Lall and Meyer, 1999, 2000, 2001; Bapela et al., 2006; van der Kooy et al., 2006; Mahapatra et al., 2007; McGaw et al., 2008) Antischistosomal (Sparg et al., 2000) Antiviral (Lall et al., 2005) Various pharmacological activities – review (Masondo et al., 2014) 20

Species

Family

Some vernacular names

Chitt.

Ficus glumosa Delile

Moraceae

Isgonswane, Umgonswane (Z)

Ficus natalensis subsp. natalensis Hochst.

Moraceae

Natal fig, bostouboom (A), idende (Z)

Galenia africana L.

Aizoaceae

Kraalbos (A)

Garcinia livingstonei T.Anderson

Clusiaceae

African mangosteen, afrikageelmelkhout (A), mokongono (NSo); muphiphi (V), igobandlovu (Z), umpimbi (Z) kannedot (A),

Gasteria croucheri Asphodelaceae

Main uses transmitted infections, blood purification, sores, healing of wounds, ulcers, as a tonic, colds, for kidney inflictions, cleanse the bladder and prostate (Mhlongo and van Wyk, 2019) Dysentery, blood purification, acne, diarrhoea, chest complaints, as a tonic (Mhlongo and van Wyk, 2019) Bark (infusion): taken during pregnancy to ensure easy childbirth Leaves (compress, poultice): wounds, boils, warts, growths) Roots (decoction): blood cleanser (Hutchings, 1996; Corrigan et al., 2011) Infusion of leaves and twigs as for scalp sores (ringworm), dry scalp, wounds, as a blood purifier, toothache, for burn wounds (Nortje and van Wyk, 2015) Uses according to traders is that pounded bark is mixed with hot water and a half a cup is drunk to strengthen the blood of a person with weak blood (Khumalo, 2018) Whole plant: protective medicine

Some related studies on pharmacological activity

Gastroprotective activity (Awolola et al., 2019) Hypolipidemic and anti-atherogenic effects (Ntchapda et al., 2015) Antimicrobial – skin (Mabona et al., 2013)

Anti-tuberculosis activity (Mativandlela et al., 2009)

Other biological properties (Mulholland et al., 2013) Antimicrobial (van Vuuren et al., 2015) Anti-oxidant activity (Muriithi et al., 2016)

Central nervous system (Stafford et al., 2007) 21

Species

Family

(Hook.f.) Baker

Some vernacular names intelezi (X)

Gnidia chrysantha Gilg.

Thymelaeaceae

Yellow heads

Gnidia cuneata Meisn.

Thymelaeaceae

Koorsbossie (A), isidikili (Z)

Gunnera perpensa L.

Gunneraceae

Qobo (Ba)

Harpagophytum procumbens (Burch.) DC. ex Meisn.

Pedaliaceae

Wool spider, duiwelsklou (A), otjihangatene (H)

Main uses against bad spirits and lightning, tonic, blood purifier, skin rashes, warts, ringworm (Philander, 2011) Root: purgative, blood purifier, boils (Watt and BreyerBrandwijk, 1962) Leaves (decoctions, pastes): respiratory diseases, sores Roots: enemas for feverish conditions, snake bite, sores, toothache, malaria, respiratory conditions, ulcers, snakebite, toothache, malaria Sap: ulcers Unspecified: blood purifier for skin eruptions (Watt and BreyerBrandwijk, 1962; Hutchings, 1996) Cancer, cleans blood, eases pregnancy, stomach ailments (Moffett, 2010; Kose et al., 2015; Mhlongo and van Wyk, 2019) Tubers (extract, infusion): arthritis (particularly of spine), cough, diarrhoea, constipation, venereal disease, blood purifier, analgesic, diseases of liver, gall bladder, pancreas, kidneys, stomach and intestines (von Koenen, 1996)

Some related studies on pharmacological activity

No relevant research

No relevant research

Numerous biological studies - review (Maroyi, 2016) Cancer (Mathibe et al., 2016) Pregnancy and labour (Kaido et al., 1997) Numerous biological studies - review (Mncwangi et al., 2012) Anti-obesity (anorexigenic) (Torres-Fuentes et al., 2014)

22

Species

Family

Harpephyllum caffrum Bernh.

Anacardiaceae

Hawthoria fasciata (Willd.) Haw.

Asphodelaceae

Heteropyxis natalensis Harv.

Myrtaceae

Heteromorpha trifoliata Eckl. & Zeyh.

Apiaceae

Some vernacular names Wild plum, suurbessie (A), umgwenya (Z)

Kannedot (A) intelezi (X)

Main uses Bark (decoction): blood purification, skin conditions such as acne or eczema, sprains, fractures, emetic (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996)

Whole plant: protective medicine against the tokoloshe and lightning, tonic, blood purifier, skin rashes, warts, ringworm (Philander, 2011) Umkhuze, Umkluza Lower back pains, blood (Z) Purification, diarrhoea, stomach cramps, as a tonic (Mhlongo and van Wyk, 2019) Kraaibos (A), Bark: colic, scrofula umbangandlala (Z) Leaves (decoctions): mental, nervous, abdominal disorders Root: cough, difficulty breathing,

Some related studies on pharmacological activity Analgesic, anti-inflammatory (Jäger et al., 1996) Analgesic and anticonvulsant (Ojewole and Amabeoku, 2007) Antibacterial, anti-inflammatory (Moyo et al., 2011) Antimicrobial, cytotoxic and hepatoprotective (Shabana et al., 2011) Antidiabetic and antihypertensive (Ojewole, 2006) Anti-oxidant (Moodley et al., 2014; Sharma and Lall, 2014) Antimicrobial (McGaw et al., 2000; Buwa and van Staden, 2006; Mabona et al., 2013) Hyperpigmentation (Mapunya et al., 2012; Lall and Kishore, 2014) UV protective (Nawwar et al., 2011) No relevant research

Antimicrobial (van Vuuren et al., 2007; Henley-Smith et al., 2018) 5-Lipoxygenase activity (Frum and Viljoen, 2006) Antibacterial (Deans et al., 1994; McGaw et al., 2000) Antihelminthic (Adamu et al., 2013) Antihypertensive (Parry and Duri, 1996) 23

Species

Family

Some vernacular names

Main uses dysentery, blood purifier, headaches, palpitations (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996)

Hoodia gordonii (Masson) Sweet ex Decne.

Apocynaceae

Hybanthus enneaspermus Jacq. Hypoxis hemerocallidea Fisch. C.A.Mey. & Ave-Lall. Hypoxis latifolia (Baker.) Hook.

Violaceae

Bitter ghaap, muishondghaap (A), wolweghaap (A), bobbejaanghaap (A), khobab (Khoi) Ungqengendleka (Z)

Hypoxidaceae

African potato, nonkwe (Z)

Hypoxidaceae

Ilabatheka (Z)

Hypoxis hemerocallidea Fisch., C.A. Mey. & Avé-Lall.

Hypoxidaceae

Ilabatheka, inkomfe, umhungulo (Z)

Inula graveolens (L.)Desf.

Asteraceae

Khakibos (A)

Used “to clean the blood”, to suppress appetite, oral thrush, measles, heartburn, stomach pains (De Beer and van Wyk, 2011)

Leaves: laxative, general tonic Root (infusion): blood purifying emetic (Hutchings, 1996) Bulb: HIV, arthritis, immune system booster, strengthens the blood (Philander, 2011) Tuber: blood cleansing emetic, lymphatic filariasis (Komoreng et al., 2017) General body pains, scabies, generate blood, blood purification, sores, septic wounds, ulcers, for childbirth, arthritis, teething, bladder and prostate, as a tonic (Mhlongo and van Wyk, 2019) Foliage: cleanses womb, lungs and blood, diabetes (Philander,

Some related studies on pharmacological activity Anti-inflammatory (Recio et al., 1995) Antiscabies (Heyndrickx et al., 1992) Antiviral (Beuscher et al., 1994) Intestinal colic (Parry et al., 1996) Oxytocic (Katerere and Parry, 2000) Review and appetite suppressant (Smith and Krygsman, 2014; Landor et al., 2015; Peters et al., 2016)

Antibacterial (Anago et al., 2011) Antiplasmodial (Weniger et al., 2004) Numerous biological studies - review (Ncube et al., 2013)

Numerous biological studies - review (Ncube et al., 2013) Various pharmacological activities – review (Ncube et al., 2013)

Numerous biological studies – review (Seca et al., 2014) 24

Species

Family

Some vernacular names

Ipomoea albivenia Sweet

Convolvulaceae

Natal cotton, umanfongo (Z)

Ipomoea purpurea (L.) Roth

Convolvulaceae

Morning glory, ijalamu (Z)

Jatropha zeyheri Sond.

Euphorbiaceae

Verfbol (A), ugogide (Z)

Kedrostis nana (Lam.) Cogn. Var. nana

Cucurbitaceae

Bitter patat (A)

Kniphofia caulescens Baker

Asphodelaceae

Red-hot poker, torch lily

Main uses 2011) Root (decoction): blood purifier enema (Watt and BreyerBrandwijk, 1962; Hutchings, 1996) Leaves and stem (infusion): blood purifier emetic Stem: purgative for stomach disorders Tubers: charms Unspecified parts: antisyphilitic (Hutchings, 1996) Shoots: sores Tuber (decoction): purgative, headaches, coughs, blood purifier Sap: burns (Watt and BreyerBrandwijk, 1962; Hutchings, 1996) Tuber: cancer, ulcers, menstrual complaints, diabetes, hypertension, constipation, blood purifier, diuretic, sores (Philander, 2011) Blood purifier (Moffett, 2010), Infertility (Moteetee and Kose, 2016)

Some related studies on pharmacological activity No relevant research

No relevant research

Treatment against sexually transmitted infections (Mongalo et al., 2017)

No relevant research

No relevant research

25

Species

Family

Some vernacular names Koorbossie (A), Isidikili (Z),

Lasiosiphon meisnerianus Endl.

Thymelaeaceae

Ledebouria cooperi (Hook.f.) Jessop Leonotis leonurus (L.) R.Br.

Hyacinthaceae

Leptjetlane (Ba)

Lamiaceae

Wildedagga (A), wild hemp, ilihambambeba (Sh), irnunyane (Z)

Limeum africanum L.

Molluginaceae

Baarbos (A)

Limeum aethiopium Burm.f. Linum thunbergii Eckl. & Zeyh.

Molluginaceae

Koggelmandervoet karoo (A)

Linaceae

Wild flax, ithalel impofu (Z)

Lobostemon fruticosus (L.) H.

Boraginaceae

8-Days

Main uses Is used by the Xhosa as a blood purifier and for skin eruptions and sores (Watt and BreyerBrandwijk, 1962; Philander, 2011) Phlegm, constipation in children, cleans blood (Kose et al., 2015) Decoction of the leaf: blood purifier, as a purgative, leprosy, skin diseases, haemorrhoids, influenza, TB, coughs and colds, snake-bite, sores, infusion drunk for blood impurity possibly related syphilis (Watt and BreyerBrandwijk, 1962; Philander, 2011) Decoction used for infants with convulsions, epilepsy, blood impurities, woman’s ailments, for retained placenta (Nortje and van Wyk, 2015) Insomnia, general medicine, purifies the blood (van Wyk, 2008) Root (infusion): blood purifying emetic, pain, snakebite, charm (Hutchings, 1996) Foliage: ringworm, skin ailments, blood purifier, stomach ache

Some related studies on pharmacological activity No relevant research

No relevant research

Numerous biological studies - review (Nsuala et al., 2015) Antimicrobial (Micota et al., 2016)

No relevant research

No relevant research

No relevant research

No relevant research

26

Species Buek Malva parviflora L.

Family

Some vernacular names

Malvaceae

Mosala supping (B)

Melianthus dregeanus Sond.

Melianthaceae

Ibonya (Z)

Melianthus pectinatus Harv.

Melianthaceae

Kriekie-roer-mynie(t) (A), kriekiebos (A), lidjiebos (A), kruidjie-roer-mynie (A)

Mentha aquatica L.

Lamiaceae

Microglossa mespilifolia (Less.) B.L.

Asteraceae

Kristemunt (A), mint, ityaleba (X), kwena-enyenyane (Sh), umnukani (Z) Ikhambi lesduli, Ikhambi elimhlophe, umazambezi (Z)

Main uses (Philander, 2011). Cleanses the blood (Mhlongo and van Wyk, 2019) Leaves (decoction): blood cleanser Bulb: “to clean the system and keep the blood clean (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Leaves: for painful legs and feet, compression for fractured legs, wounds, sores and abrasions, leaf infusion for influenza. Root: decoction for urinary tract infections, blood purifier, headache (Nortje and van Wyk, 2015) Blood purifier (Moffett 2010), mouthwash, digestion (http://paulkirtley.co.uk/2011/wat er-mint-mentha-aquatica/) Back pains, fever, sexually transmitted diseases, chicken pox, scabies, blood cleanser, itching, clear nasal congestion, colds and flu, stomach ache, measles and other body rashes, sores, constipation, as a tonic, urinary infections (Mhlongo and van

Some related studies on pharmacological activity Anti-inflammatory activity (Shale et al., 2005; Ramírez-Serrano et al., 2019) Antimicrobial (Shale et al., 2005) No relevant research

No relevant research

Antimicrobial (Ferhat et al., 2017)

No relevant research

27

Species

Family

Some vernacular names

Main uses

Some related studies on pharmacological activity

Wyk, 2019) Myrsine africana L.

Myrsinaceae

Ornithogalum flaccidum (Jacq.) J. C. Manning & Goldblatt

Hyacinthaceae

Parinari curatellifolia Planch. ex Benth.

Chrysobalanaceae Boomgrysappel (A), cork tree, mola (Ts), muhacha (Sh) Geraniaceae Unyawo lwenkukhu, Uvendle (Z)

Pelargonium luridum (Andrews) Sweet Pelargonium triste (L.) L’Her

Peltophorum africanum Sond.

Wild myrtle, umqanc (Z), wi!demirting (A), morokwana (Sh) White onion, inqwebeba (X,Z)

Geraniaceae

Kaneelbol (A), rooirabas (A)

Fabaceae

False black wattle, muzeze (Sh), umsehla (Nd)

Leaf: decoction as a blood purifier possibly for syphilis (Watt and Breyer-Brandwijk, 1962) Bulbs: blood purifier, cholesterol, hypertension, cancer, ulcers, cleans the womb and blood in the stomach (Philander, 2011) Bark: blood tonic, cardiac stimulant, respiratory infections, eyes (Watt and Breyer-Brandwijk, 1962) Blood purification, diarrhoea, as a tonic (Mhlongo and van Wyk, 2019)

Antimicrobial (Ahmad et al., 2016)

Tuber: haemorrhoids, internal bleeding, tuberculosis, respiratory problems water retention, chest ailments, dysentery, anaemia, diarrhoea, blood purifier (Philander, 2011) Bark or root (decoction, infusion): diarrhoea, nausea Bark and root (infusion): remedy for all diseases (panacea) Leaves (wash, steam): to drive

Antimicrobial (Scott et al., 2004)

No relevant research

Antibacterial and haemolytic (Karou et al., 2011)

No relevant research

Numerous biological studies - review (Mazimba, 2014) Anti-inflammatory (Adebayo et al., 2015)

28

Species

Family

Some vernacular names

Pentanisia prunelloides Walp.

Rubiaceae

Wild verbena, ngelile (Sh), sooibrandbossie (A), icitshamliloomkhul u (Z)

Piper volkensii C. DC.

Piperaceae

Wild pepper, bospeper (A)

Polygala virgata Thunb.

Polygalaceae

Pittosporum viridiflorum Sims

Pittosporaceae

Pride of Manicaland bloukappie (A), furambuku (Sh) Cheesewood, bosboekenhout (A),

Main uses away bad spirits, toothache Root (decoction, infusion, powder): dropsy, sore eyes, venereal disease, prevent witches from getting into house, diuretic, diaphoretic, blood purification, sores on throat, oedema, prevent abortion, infertility in women, chest pain; Root or bark or leaves: abdominal pain Whole plant: Madness (Gelfand, 1985) Root: stomach pains, swellings, rheumatism, sprains, wounds, scrofula sores, fevers, colds, fevers, gonorrhoea leaf : swellings, rheumatism, sprains, sores, fevers blood purification, STIs (Watt and Breyer-Brandwijk, 1962) blood purifier, sores, stomach ache (Watt and Breyer-Brandwijk, 1962) Blood purifier (Moffett, 2010)

Bark (decoction): fever, back pain, stomach complaints

Some related studies on pharmacological activity

Anti-inflammatory (Frum and Viljoen, 2006) Antimicrobial (Jäger and Eloff, 2003; Mabona et al., 2013)

Antiviral (Beuscher et al., 1994)

Immune function (Ottendorfer et al., 1994)

Anti-amoebic and antibacterial (McGaw et al., 2000) 29

Species

Family

Some vernacular names umkwenkwe (Z)

Polygala fruticosa P.J.Bergius

Polygalaceae

Ithethe (Z)

Polygala oppositifolia L.

Polygalaceae

Tete (Z),

Polygala virgata Thunb.

Polygalaceae

Polygonum hystriculum J. Schust. Protasparagus suaveolens (Burch.) Oberm

Polygonaceae

Purple broom, bloukappie (A), ujulwezinyosi (Z) n≠aun≠au (B)

Protorhus

Asparagaceae

Anacardiaceae

Bushveld asparagus, katdoring (A), mvane (X), wild asparagus Inhluthe, isifuce,

Main uses connected to bile, blood purification, emetic. Roots and bark: aphrodisiac Root (infusion): chest pain, enema for dizziness, blood purification (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Root (decoction, snuff): blood purifier, easy delivery, dropsy, diseases affecting veins and arteries, weakness of legs due to poor circulation, intestinal sores, gonorrhoea, chronic ulcers, head congestion (Hutchings, 1996) Root: TB, blood purifier, produces perspiration, for scrofula (Watt and Breyer-Brandwijk, 1962) Root (infusion): blood purifying emetic (Hutchings, 1996)

Some related studies on pharmacological activity Anti-oxidant (Otang et al., 2012) Antimalarial (insecticidal) (Muthaura et al., 2007; Maharaj et al., 2011)

Anti-inflammatory (Madikizela et al., 2014) Antimicrobial (van Vuuren and Naidoo, 2010)

No relevant research

Antiviral (Beuscher et al., 1994)

Root (decoction): retained placenta, blood purifier (von Koenen, 1996) Plant: blood purifier Root (infusion): pulmonary tuberculosis (von Koenen, 1996)

Anti-inflammatory (Dzoyem et al., 2017)

Blood purifier, warts, nausea,

Antimycobacterial activity (Kabongo-Kayoka

No relevant research

30

Species

Family

longifolia (Bernh.) Engl.

Some vernacular names uzinhla (Z)

Pterocarpus angolensis DC.

Fabaceae

Transvaal teak, kiaat (A), bloedhout (A), morôtô (S), mokwa (T); umvangazi (Z)

Ptaeroxylon obliquum (Thunb.) Radlk.

Rutaceae

Sneezewood, nieshout (A), umthathe (X, Z)

Pterocelastrus echinatus N. E. Brown

Celastraceae

White candlewood, witkershout (A), isihlumanye (Z)

Main uses constipation, as a tonic, diuretic (Mhlongo and van Wyk, 2019) Bark: magical healing powers concerning the blood, earache, menorrhagia Roots: infertility Sap: sore eyes Not specified: diarrhoea, heavy menstruation, nose bleeding, headache, stomach ache, schistosomiasis, sores and skin problems (Maroyi, 2011) Root (decoction): blood purification Sap (topical application): wart removal Wood: anthrax, fits, sinusitis Wood or bark (infusion, snuff): rheumatism, arthritis and cardiac troubles, headache, fever Young branches (tea): urinary and bladder complaints (Hutchings, 1996; Mhlongo and van Wyk, 2019) Root (decoction): digestive and blood cleansing purgative Bark (decoction): emetic for respiratory ailments (Hutchings, 1996)

Some related studies on pharmacological activity et al., 2016) Anti-oxidant and antiplatelet activity (Suleiman et al., 2010) Antibacterial and cytotoxicity activities (Samie et al., 2009)

Antimalarial (insecticidal) (Maharaj et al., 2011) Antiproteus (rheumatoid arthritis) (Cock and van Vuuren, 2014)

No relevant research

31

Species

Family

Celastraceae Pterocelastrus rostratus (Thunb.) Walp.

Some vernacular names Red candlewood, rooikershout (A), usahlulamanye (Z)

Pterocelastrus tricuspidatus (Lam.) Sond.

Celastraceae

Cherrywood, witpeer (A), usahlulamanye (Z)

Pteronia camphorata (L.) L

Asteraceae

Wakkerbos (A), koorsbos (A)

Rapanea melanophloeos (L.) Mez

Primulaceae

Cape beech, kaapse boekenhout (A), mogono (NSo), isiqwane-sehlathi (X), umaphipha (Z)

Raphionacme velutina Schltr.

Apocynaceae

Umathanjana (Z)

Rauwolfia caffra Sond.

Apocynaceae

Quinine tree, koorsboom (A), umkhabamasi (Z)

Main uses Bark (decoction): emetic for respiratory ailments Root: digestive and bloodcleansing purgative, spinal disease (Hutchings, 1996) Bark (decoction): emetic for respiratory ailments Root: digestive and blood cleansing purgative (Hutchings, 1996) Leaves and twigs: for toothache, flatulence, tuberculosis, general Malaise, tonic rheumatism, blood purifier, dry leaves for earache, convulsions and epilepsy. Roots: for infants with febrile convulsions (Nortje and van Wyk, 2015; Hulley et al., 2016) Uses according to traders is that bark decoctions are used for cleaning the blood (Khumalo, 2018; Mhlongo and van Wyk, 2019) Root (decoction): blood purifier, scrofula, worm infestation, debility, chronic ulcers (Hutchings, 1996) Bark: measles, urticaria, other rashes, fever emetic, cough, uterine complaints, abdominal

Some related studies on pharmacological activity No relevant research

No relevant research

Antimicrobial (Hulley et al., 2016)

Antimicrobial, anti-oxidant activity and antiplatelet aggregation activity (Mosa et al., 2011)

Anti-neoplastic (Charlson, 1980)

Antiplasmodial (Bapela et al., 2014)

32

Species

Rhamnus prinoides L'Hér.

Family

Rhamnaceae

Rhoicissus digitata Vitaceae (L.f.) Gilg & M. Brandt

Some vernacular names

Dogwood, blinkblaar (A), umyenye (Z)

Uchititibhunga (X, Z)

Rhoicissus tomentosa (Lam.) Wild & R.B. Drumm.

Vitaceae

Amagrebhisi enyoka, isende lengulube, isinwazi, insema (Z)

Ricinus communis L.

Euphorbiaceae

Uhlakuva, umhlakuva, (Z)

Rumex crispus L.

Polygonaceae

Curled dock, narrow-leaved

Main uses complaints, dropsy, rheumatism Leaves: headache, tranquiliser Rootbark (decoction): blood purifier (Hutchings, 1996) Root (decoction): blood purifier, pneumonia, emetic, mental disorders Unspecified parts: sprains (Hutchings, 1996) Bulbs: enema for blood purification and intestinal cleansing, gastrointestinal complaints, cancer, an amulet that destroys gossip (Philander, 2011). Chronic headache, blood purification, acne, cleanser for nasal passages, ease childbirth, pregnancy, as a tonic (Mhlongo and van Wyk, 2019) Blood purification, sores, skin problems, body ointments, swollen glands, constipation, inflammation, teething related ailments in babies, Kidneys and bladder problems, ease childbirth, swollen testicles, as a tonic (Mhlongo and van Wyk, 2019) Rhizome: toxic laxative, purgative, skin diseases, eczema,

Some related studies on pharmacological activity

Acetylcholinesterase inhibition (Crowch and Okello, 2009) Antimalarial (Muregi et al., 2003; Muregi et al., 2007a; Muregi et al., 2007b) Anti-inflammatory and antimicrobial (Lin et al., 1999)

Epilepsy and convulsions (Risa et al., 2004)

Various biological activities- review (Ribeiro et al., 2016)

Antibacterial (Orbán-Gyapai et al., 2017)

33

Species

Family

Some vernacular names dock, tongblaar (A), idololenkonyana (X), uhuklunga (Z)

Dwarf marigold, ruhwahwa (S)

ringworm, leprosy, urticarial, scrofula, herpes, blood purifier (Watt and Breyer-Brandwijk, 1962) Root (infusion): tapeworm, infantile diarrhoea, dysmenorrhea; Rhizome (decoction): sterility Plant (decoction): wash wounds and bruises, sprains, blood purifier (Watt and BreyerBrandwijk, 1962; Hutchings, 1996; Moffett, 2010) Rhizome: astringent, skin diseases, blood purifier, purgative, anthrax, tapeworm. (Watt and Breyer-Brandwijk, 1962) Blood purifier (Moffett, 2010) As a disinfectant after sickness (Watt and Breyer-Brandwijk, 1962) Foliage: diabetes, blood cleansing, diuretic (Philander, 2011) Hypertension, blood purifier (Semenya et al., 2012)

Idumbe likahloyile, (Isangoma), uhloyile

Blood purifier, fever, malaria, toothache, nausea chest congestion, chest

Rumex lanceolatus Thunb.

Polygonaceae

Common dock, tongblaar (A), idolo lenkoyane (Z)

Rumex obtusifolius L.,

Polygonaceae

Bitter dock, broadleaved dock

Salvia runcinata L. f.

Lamiaceae

Wildesalie (A), mosisili (S)

Salicaceae Salix mucronata Thumb. subsp. mucronata Schkuhria pinnata Asteraceae (Lam.) Kuntze ex Thell Amaryllidaceae Scadoxus puniceus (L.) Friis & Nordal

Main uses

Wide wilger (A), willow

Some related studies on pharmacological activity

No relevant research

Antibacterial (Orbán-Gyapai et al., 2017)

Biological activities including other Salvia species- review (Kamatou et al., 2008)

Anti-inflammatory, anti-cholinesterase and mutagenic effects (Eldeen et al., 2005) Antimicrobial (Eldeen and van Staden, 2007) Hypoglycaemic activity (Deutschländer et al., 2009) Acetylcholinesterase inhibition and antioxidant activity (Adewusi and Steenkamp, 2011) 34

Species

Family

Schoenoplectus scirpoides (Schrad.) Browning

Cyperaceae

Schotia brachypetala Sond.

Fabaceae

Sclerocarya birrea (A.Rich.) Hochst.

Anacardiaceae

Some vernacular names umphompo (Z)

Igceba, incema yamadoda, induma, ingqumba, ingcingolo, ingqumbe (Z) Ihluze, Ingwavuma (Z)

Marula, maroela (A), umganu (Z)

Main uses complaints, bladder and kidney complaints (Mhlongo and van Wyk, 2019) Blood purification, childbirth (Mhlongo and van Wyk, 2019)

Blood purification, blood regeneration, skin problems, colds and flu, as a tonic (Mhlongo and van Wyk, 2019) Bark (decoction): enemas for malaria and diarrhoea, tea to strengthen heart, blood cleansing emetic before marriage, proctitis, fever, headache, backache, toothache, ulcers, infertility, menorrhagia, schistosomiasis, sore eyes, heart pain (Gerstner, 1938; Pujol, 1990; Hutchings, 1996; Mhlongo and van Wyk, 2019)

Some related studies on pharmacological activity

No relevant research

Anti-oxidant, antibacterial, antimalarial and acetylcholinesterase inhibitory activities (Adewusi and Steenkamp, 2011; Du et al., 2014) Numerous biological studies – review (Ojewole et al., 2010) Antibiofilm (Sarkar et al., 2014) Anticancer (Tanih and Ndip, 2013) Antidiabetic (Mogale et al., 2011; Mousinho et al., 2013) Antihelminthic (Koné et al., 2012) Anti-inflammatory and antimicrobial (Moyo et al., 2011) Antimicrobial (Njume et al., 2011; Tanih and Ndip, 2012; York et al., 2012; Naidoo et al., 2013; van Vuuren et al., 2015) Anti-oxidant (Sharma and Lall, 2014) and proapoptotic (Armentano et al., 2015) Hyperpigmentation (Lall and Kishore, 2014) Uterotonic (Attah et al., 2012) Vasorelaxant (Belemtougri et al., 2001) Vasospasmodic (Mawoza et al., 2012) 35

Species

Family

Senecio serratuloides DC.

Asteraceae

Sideroxylon inerme L.

Sapotaceae

Sonchus oleraceus Asteraceae L.

Sphenostylis augustifolia Sond.

Fabaceae

Some vernacular names Two-day cure, insukumbili (Z)

White milkwood, witmelkhout (A), umqwashu, (X), Mutaladzi-vhufa (V), umakhwelafinqane, amasethole (Z)

Main uses Leaves (decoction, tea, powder): blood purifier for skin eruptions, purulent sores, infection, applied to burns and sores Unspecified parts: swollen gums, chest pain; purgative (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996; Moffett, 2010) Uses according to traders is that the bark is used to chase away evil spirits, and for mental illnesses. Bark is used in mixtures ‘izimbiza’ and for the treatment of kidneys and for cleaning the blood (Khumalo, 2018)

Milk thistle, melkdissel (A)

Plant (expressed, ointment): wounds, ulcers, eye complaints, blood purifier, liver complaints, purgative Root: helminthiasis (Watt and Breyer-Brandwijk, 1962; von Koenen, 1996)

Wild sweet pea, wilde-ertjie (A), ithethe (Z)

Leaf (infusion): blood and stomach cleansing emetics (Hutchings, 1996)

Some related studies on pharmacological activity Enhanced cutaneous wound healing (Gould et al., 2015)

Anti-oxidant activity. The methanol extract also exhibited reduction of melanin content in melanocytes without being potentially toxic to the cells (Momtaz et al., 2008; Lall and Kishore, 2014). Antimicrobial against skin pathogen Cutibacterium acnes (Sharma and Lall, 2014) Anti-aging and anti-oxidant (Ou et al., 2015) Antibacterial and cytotoxic (Elkhayat, 2009) Antidiabetic (Teugwa et al., 2013) Anti-inflammatory (Vilela et al., 2010) Antinociceptive (Vilela et al., 2009a) Anxiolytic (Vilela et al., 2009b) Cytotoxic (Zhao et al., 2012) Prebiotic (Kassim et al., 2014) Prevention of gastric ulcers (Li et al., 2015) No relevant research

36

Species

Family

Some vernacular names Tamboti, tambotie (A), umthombothi (Z), ndzopfori (Ts), muonze (V)

Spirostachys africana Sond

Euphorbiaceae

Stellaria media (L.) Vill.

Caryophyllaceae

Chickweed, qoqobala (Sh)

Stephania abyssinica Quart.-Dill. & A.Rich.

Menispermaceae

Umbombo (Z)

Sutherlandia microphylla Burch. ex DC.

Fabaceae

Wildekeur (A), kalkoenbel (A), kankerbos (A)

Main uses

Some related studies on pharmacological activity Bark: purgatives for constipation, Antimicrobial (Mathabe et al., 2008; renal ailments, blood purification Akhalwaya et al., 2018) and kidney disease, ointment for rashes in infants (Pujol, 1990; Hutchings, 1996; Grace et al., 2003) Blood purifier (Moffett, 2010) Anti-oxidant and antifungal properties (Bordoloi et al., 2016) Non specified parts have been used for haemorrhoids, eye inflammations, blood diseases and eczema (Watt and BreyerBrandwijk, 1962) Juice of stem: emetic for chest pain Leaves (infusion): purgative for children Root (decoction): blood purifier for boils, roundworm, menorrhagia (Hutchings, 1996) Leaf: stomach and intestinal complaints, internal cancers, uterine troubles, influenza, liver diseases, rheumatism, inflammations, haemorrhoids, sexually transmitted diseases, backache, eyes, wounds, dysentery, high blood pressure, back and kidney pain, as general cleanser or blood purifier,

Antihypertensive (Nguelefack et al., 2015) Antiplasmodial (Muregi et al., 2004; Omole et al., 2014)

Numerous biological studies – review (van Wyk and Albrecht, 2008)

37

Species

Family

Some vernacular names

Taraxacum officinale F.H.Wigg.

Asteraceae

Dandelion

Thesium hystrix A.W. Hill

Santalaceae

Witopslag (A)

Thesium lineatum L.f.

Santalaceae

Black storm, sawrtstrom (A)

Trichilia emetica Vahl

Meliaceae

Natal mahogany, rooiessenhout (A), umkhuhlu (Z), umkhuhlu (X), mutuhu (V)

Trifolium

Leguminosae

Burchell's clover,

Main uses infusion is taken as a blood tonic, coughs, as a purgative cancer (Smith, 1895; Watt and Breyer-Brandwijk, 1962; van Wyk et al., 2009) Root: used as a tonic, disease of the liver, dyspepsia, as a purgative, diuretic, liver troubles, jaundice, blood purifier, the juice as eye drops (Watt and Breyer-Brandwijk, 1962) Root: TB, kidney and bladder inflictions, blood purifier (Watt and Breyer-Brandwijk, 1962) Root: diabetes, cancer, gastrointestinal complaints, headache, blood purifier. Amulet for court cases (Philander, 2011) Bark: enemas are administered for kidney ailments, as blood cleansers and for intestinal worms. Also for stomach and intestinal complaints, lumbago, rectal ulceration in children and dysentery, wound healing, syphilis and cirrhosis. (Hutchings, 1996; van Wyk et al., 1997; Grace et al., 2003; van Wyk et al., 2009) Blood purifier (Moffett, 2010)

Some related studies on pharmacological activity

Numerous biological studies – review (Martinez et al., 2015)

No relevant research

No relevant research

Numerous biological studies – review (Komane et al., 2011)

No relevant research on this particular species 38

Species

Family

burchellianum Ser. Tropaeolum majus Tropaeolaceae L.

Some vernacular names cape clover, musapelo (Sh) Nasturium

Meliaceae

Umhla thalana (Z)

Typhaceae

Papkuil (A), zaza (B)

Urginea burkei Baker

Hyacinthaceae

Giftulp (A), slangkop (A), sekanama (Sh),

Urera tenax N. E. Br.

Urticaceae

Stinging nettle

Turraea obtusifolia Hochst. Typha capensis (Rohrb.) N.E.Br.

Main uses

Some related studies on pharmacological activity

Infections related to the urinary tract, inflammation of the kidney, sores, blood purifying, antibacterial (Watt and BreyerBrandwijk, 1962) Blood purifier (Semenya and Potgieter, 2014)

Anti-inflammatory (Bazylko et al., 2013) antimicrobial (Bazylko et al., 2013) diuretic effects (Junior et al., 2012; Barboza et al., 2014)

Root (tea): expulsion of placenta, labour, diarrhoea, enteritis, blood purifier Stem: STIs (von Koenen, 1996; Mhlongo and van Wyk, 2019) Bulb: is mixed with water and taken in small doses as a blood purifier, ground and put into a vessel into which the sick person urinates. In the evening the urine is applied to the foot for rheumatic pains (Watt and Breyer-Brandwijk, 1962) Gout, rheumatism Leaf and seed: internal haemorrhages, purgative, diuretic, oedema, haemorrhoids, urticaria, jaundice, dysentery, bronchial catarrh, eczema Nettle: expectorant, blood

Free radical scavenging (Henkel et al., 2012)

No relevant research

No relevant research

No relevant research

39

Species

Family

Some vernacular names

Vernonia oligocephala (DC.) Sch.Bip.

Asteraceae

Silver leaved vernonia

Vinca minor L.

Apocynaceae

Periwinkle

Vitellariopsis marginata (N.E.Br.) Aubrév.

Sapotaceae

Flat-cap milkwood, umphumbulu (Z)

Withania somnifera (L.)Dunal

Solanaceae

Ubuvimbha (Z)

Ximenia caffra Sond.

Olacaceae

Umthunduluka (Z)

Zanthoxylum capense (Thunb.)

Rutaceae

Cardamon, knopdoring (A),

Main uses purifier, wounds, sores (Watt and Breyer-Brandwijk, 1962) Leaves: slimming and blood purifier; abdominal pain, diarrhoea, obstipation, septic colitis, diabetes, rheumatism, purgative (Hutchings, 1996) A decoction of the leaf: astringent and carminative, blood purifier, diarrhoea, dysentery, wounds (Watt and Breyer-Brandwijk, 1962) Roots: indigestion, blood poisoning Root and leaves (decoction): blood purifiers, strengtheners, sexual stimulants (Hutchings, 1996) Infusion as a blood tonic (Asowata-Ayodele et al., 2016) Unspecified: for miscarriage, intestinal parasites introduced by witchcraft, syphilis, typhoid Leaf: bed-sores (Watt and BreyerBrandwijk, 1962) Blood purification, nausea, to ease childbirth, chest complaints (Mhlongo and van Wyk, 2019) Fruit: colic, palsy, stomach ache, Leaves: applied on sores,

Some related studies on pharmacological activity

Antiplasmodial (Clarkson et al., 2004)

Other pharmacological activities but not as specified under main use

Anti-inflammatory (Ndhlala et al., 2011)

Numerous biological studies – review (Kulkarni and Dhir, 2008)

Numerous biological studies – review (Maroyi, 2016) Antibacterial (Luo et al., 2012) Anticonvulsant (Amabeoku and Kinyua, 40

Species

Family

Harv.

Ziziphus mucronata Willd.

Rhamnaceae

Some vernacular names umlungumabele (Z)

Blinkblaar (A), buffelsdoring (A), mokgalo (Ts), rnokhalo (Z), mupakwe (Sh)

Main uses toothache, purgative, parasiticides, stomach complaints, febrile conditions, head colds, influenza, gastric and intestinal disorders Rootbark (decoction): blood purifier, scrofula, enema for stomach complaints, pleurisy, chronic cough, snakebite, toothache, anthrax, tonic, epilepsy, blood tonic, purgative, backache Leaf: dressing for bronchitis, mouthwash, acne (Gerstner, 1938; Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Fruit: colic, stomache ache Leaf: gastric and intestinal disorders, parasites, coughs, pleurisy, purgative Bark: tonic, sores, blood impurities, snakebite, coughs, pleurisy, toothache, TB, epilepsy, pimples Root: bronchitis, mouthwash, acne (Watt and Breyer-Brandwijk, 1962)

Some related studies on pharmacological activity 2010) Antifungal (Mokoka et al., 2010; Adamu et al., 2012) Anti-inflammatory (Adebayo et al., 2015) Antimycobacterial (Luo et al., 2011; Luo et al., 2013) Neuroprotective (Seoposengwe et al., 2013)

Anti-oxidant and toxicity (Elgorashi et al., 2003) Anaemia (Mpiana et al., 2008) Antimicrobial (Mabona et al., 2013) Anthelmintic (Waterman et al., 2010)

A - Afrikaans, Ba -Basotho, B - Bushmen, D - Damara, Nd - Ndebele, NSO – northern Sotho Ky - Kwanyama, P – Pondo, Sh - Shona, Sha Shangana Ses – Sesotho, Ts – Tswana, V – Venda, X - Xhosa, Z - Zulu 41

Table 3 Plant families mentioned as blood purifiers. Number of occurrences 1

2

3 4 6 10 11 13

Family Aizoaceae, Amaranthaceae, Araliaceae, Capparaceae, Caprifoliaceae, Chenopodiaceae, Chrysobalanaceae, Clusiaceae, Combretaceae, Compositae, Curtisiaceae, Cyperaceae, Ebenaceae, Gentianaceae, Gunneraceae, Leguminosae, Malvaceae, Myrtaceae, Myrsinaceae, Olacaceae, Pedaliaceae, Phyllanthaceae, Pittosporaceae, Primulaceae, , Salicaceae, Tropaeolaceae, Linaceae, Typhaceae, Urticaceae, Violaceae Amaranthaceae, Amaryllidaceae, Annonaceae, Apiaceae, Boraginaceae, Caryophyllaceae, Convolvulaceae, Cucurbitaceae, Geraniaceae, Molluginaceae, Moraceae, Rhamnaceae, Rubiaceae, Sapotaceae, Santalaceae, Solanaceae, Vitaceae. Anacardiaceae, Hypoxidaceae, Meliaceae, Melianthaceae, Menispermaceae, Lamiaceae, Poaceae, Thymelaeaceae Asparagaceae, Celastraceae, Polygalaceae, Rutaceae Apocynaceae, Euphorbiaceae, Hyacinthaceae, Fabaceae Asphodelaceae Asteraceae

Table 4 Multiple species from the same family used for blood purification. Genus

Species

Acacia

caffra; chariessa

Aloe

arborescens; ferox; greatheadii; striatula; zebrina

Annona

senegalensis; stenophylla

Asparagus

stipulaceus; capensis

Bulbine

alooides; latifolia; narcissifolia

Gnidia

chrysantha; cuneata

Hypoxis

hemerocallidea; latifolia

Ipomoea

albivenia; purpurea

Limeum

africanum; aethiopium

Melianthus

dregeanus; pectinatus

42

Genus

Species

Polygala

fruticose; virgate; oppositifolia

Pterocelastrus

echinatus; rostratus, tricuspidatu

Rumex

obtusifolius; crispus; lanceolatus

Thesium

hystrix, lineatum

bark/stems/ twigs 13%

flowers/fruit 1%

unspecified/ whole plant 22%

roots/rhizomes/ tuber 41%

leaves 23% Fig. 1. Plant parts used as blood purifiers

The common name of the tree is ‘blood wood” and when cut, the tree oozes a reddish liquid resembling blood. This is often used for rituals and is associated with magical properties (van Wyk and Gericke, 2000; Maroyi, 2011). There is a link between the magical properties of a plant and blood letting or the spilling of blood as was clearly noted in a study of the Basotho people from Lesotho in comparison with other cultural groups in southern Africa (Moteetee, 2017).Other plant species used as a blood purifier and having a spiritual link can be found in Table 5. These may include anything from charms to love potions and even a protective medicine to ward off the tokoloshe (a mischievous evil spirit of Zulu mythology).

Table 5 43

Blood purifier plants linked to a spiritual use.

Species

Spiritual connection (references)

Abrus precatorius

Root (infusion): infertility; Seed: charm to remain young or lucky (Gelfand, 1985) Root: charm (Hutchings, 1996; Venter and Venter, 1996)

Acacia caffra Albizia adianthifolia Annona senegalensis Bowiea volubilis Capparis tomentosa Gasteria croucheri Hawthoria fasciata Heteromorpha trifoliata Ipomoea purpurea Linum thunbergii Peltophorum africanum

Pittosporum viridiflorum Pterocarpus angolensis Rauwolfia caffra Rhamnus prinoides Rhoicissus digitata Sclerocarya birrea Sideroxylon inerme Spinacia oleracea Thesium lineatum Vinca minor Vitellariopsis marginata Withania somnifera

Bark: love charm (Watt and Breyer-Brandwijk, 1962) Lucky charm (Gelfand, 1985) Love charm (Philander, 2011) Charms (Hutchings, 1996) Protective medicine against bad spirits and lightning (Philander, 2011) Protective medicine against the tokoloshe and lightning (Philander, 2011) Mental and nervous disorders (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Tubers: charms (Hutchings, 1996) Charm (Hutchings, 1996) Leaves (wash, steam): to drive away bad spirits Root (decoction, infusion, powder): prevent witches from getting into house. Whole plant: madness (Gelfand, 1985) Roots and bark: aphrodisiac (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Bark: magical healing powers (Maroyi, 2011) Leaves: tranquiliser (Hutchings, 1996) Mental disorders (Hutchings, 1996); protective powers against witchcraft (Moteetee, 2017) An amulet that destroys gossip (Philander, 2011) Bark (decoction): blood cleansing emetic before marriage, (Gerstner, 1938; Pujol, 1990; Hutchings, 1996) Bark is used to chase away evil spirits (Khumalo, 2018) Useful in diseases of brain (Asowata-Ayodele et al., 2016) Amulet for court cases (Philander, 2011) A decoction of the leaf: astringent and carminative (Watt and Breyer-Brandwijk, 1962) Root and leaves (decoction): strengtheners, sexual stimulants (Hutchings, 1996) Intestinal parasites introduced by witchcraft (Watt and BreyerBrandwijk, 1962)

44

4.

Toxicity

A number of plant species (for example Abrus precatorius, Cissampelos capensis, Datura stramonium, Thesium lineatum and Gnidia spp. amongst others) linked to the traditional use of a blood purifier (Table 2), are also well-known for their cytotoxicity. It would appear that the toxicity aids in purging and thus assists in ridding the body of unwanted toxins aiding in blood purification. African traditional healers are very specific with the dosing of these medicinal plants ensuring the holistic well-being of the patient. A typical example of how the traditional use of a toxic plant can be overcome is observed with the administration of Urginea burkei. The bulb is mixed with water and taken in small doses as a blood purifier. Furthermore, the ground bulb is placed into a vessel into which the sick person urinates. In the evening the urine is applied to the foot for rheumatic pains (Watt and Breyer-Brandwijk, 1962).

5.

Medicinal use in addition to blood purification

In terms of the main uses of the plant species, rarely was the scope of treatment limited to blood purification and many of the plant species were listed for a variety of, and for seemingly unrelated and sometimes idiosyncratic, conditions. It is possible that many of these plant species may be used as adjuvants in imbizas (tonics administered as a mixture of herbs and are usually purgatives or enemas) (Olivier, 2012). Only A. striatula, A. thunbergii C. album, M. dregeanus, P. virgata T. burchellianum and T. obtusifolia had blood purification as its sole use. Fig. 2 provides an overview of the various additional medical treatments, which are ascribed to the medicinal plants used for blood purification. Ailments shaded in black incorporate infectious diseases and these make up the majority of the medicinal uses documented for plants used as blood purifiers. Top of the list of the most highly cited disease condition is stomache ailments. There is a direct link to blood purification as one of the most frequent uses of a blood purifier is as a laxative. Furthermore, a patient feeling unwell regularly presents with an uncomfortable stomache which includes symptoms of cramps, bloating and nausea. A blood purifier is then prescribed to alter the disordered metabolic and catabolic processes associated with the breakdown and elimination of metabolic waste. This will enhance improved absorption and assimilation of nutrients and serve to balance and

45

Fig. 2. Incidence of disease conditions mentioned with plant species associated with blood purification ( with an infectious disease;

plant species that may be associated

plant species associated with non- infectious conditions)

46

normalize the overall physiological chemistry of the body and thereby restore vital health (Smith, 2019). The second most frequent medical condition associated with the use of a blood purifier are those related to the skin. This is not surprising as it is common knowledge that skin conditions especially acne, boils and rashes are associated with “bad blood” and are often treated with detoxification as a form of cleansing.

6.

Blood purification mixtures

There is very little, if any reference to plant species used in combination as a blood purifier. The closest relevance was that where P. prunelloides is used to alleviate the effects of an enema where Dierama pendulum (L.f.) Baker is used and even that reference can be considered tenuous. There have, however, been a number of commercial mixtures marketed as blood purifies over the ages. This clearly denotes the popularity and marketability of such prepared products, as well as emphasises the traditional belief in such preparations. A range of historical products are displayed (Fig. 3.) courtesy of the South African Pharmacy Museum (Johannesburg, South Africa). It is interesting to note that the Aloe species is listed in products a. and c., and all link to the treatment of constipation. The package insert, where available, was dated 1972-1974.

a.)

b.)

c.)

d.)

a.)

Fig. 3. Blood products (a-d) used historically courtesy of the Pharmacy Museum (Johannesburg, South Africa). 47

Furthermore, current products (Fig. 4.) sold on the over the counter market in selected ethnic areas of South Africa denote the popularity and need of such products.

a.)

b.)

Fig. 4. Over the counter products (a-b) denoting blood purification.

7.

Discussion and future recommendations

7.1. Summary of research undertaken

The majority of the research output focused on anti-infective investigations (at least 77%). This correlates with the highest frequency of plant use as indicated in Fig 2., where stomache, skin and respiratory ailments top the list of most frequently documented. Such antimicrobial studies may be ascribed to firstly, the ease and relative low cost of in vitro testing which may outweigh investigations into other more complex uses. Secondly, the race against the imminent redundancy of current antibiotics may add a sense of urgency. While there is abundant evidence of antimicrobial testing, there has been little, if any, attention given to pathogens specifically related to the blood. Infectious diseases directly related to the blood may include viruses (hepatitis B, hepatitis C HIV, Human T-lymphotropic virus type I, viral hemorrhagic fever); parasites (Plasmodium falciparum (Malaria); bacteria (syphilis, staphylococci, streptococci, Acinetobacter species, Enterobacteriaceae, Aromonas spp., Listeria monocytogenes, Haemophilus influenzae, Klebsiella spp.; anaerobes (Bacteroides 48

spp., Clostridium perfringens, Peptococcus spp. etc.) and fungi amongst others. Furthermore, as skin inflictions are noted as the second highest indication of use, more attention should be given to Cutibacterium acnes (formally known as Propionibacterium acnes), as a study pathogen responsible for acne. Some plant species, for example, E. elephantina, G. perpensa, H. caffrum and Z. mucronata have shown excellent anti- P. acne activity when tested against both organic and aqueous extracts (Mabona et al., 2013). Thus, further studies on other plant species indicated herein are warranted. Well studied plant species (A. precatorius, Aloe spp., A. afra, A. phylicoides, B. volubilis, D. stramonium, H. procumbens, Hypoxis spp., L. leonurus, P. africanum, S. birrea, S. microphylla, T. officinale. T. emetica, and W. somnifera) are listed as blood purifiers and these are accompanied by review articles providing a comprehensive overview of many pharmacological studies (Table 2.). It is interesting to note that from these reviews little research can be ascribed to confirm that these plant species “cleanse the blood” or have any positive correlation to blood health. In fact, from the 139 species linked to blood purification, only a handful can be linked to actual studies pertaining to blood health. These include bronchodilatory activity and cardioprotective properties of A. afra (Mjiqiza et al., 2013), anti-platelet aggregation activity from P. longifolia and R. melanophloeos (Mosa et al., 2011), vasorelaxant and vasospasmodic activity of S. birrea (Belemtougri et al., 2001). Antihypertensive activity was observed for S. abyssinica (Nguelefack et al., 2015), H. trifoliata (Parry et al., 1996), E. capensis (Kamadyaapa et al., 2009), C. anisata (Duncan et al., 1999) and H. caffrum (Ojewole, 2006). Hypertriglyceridemia is defined as having high levels of triglycerides (the most abundant fatty molecule in most organisms). Elevated levels of triglycerides are associated with atherosclerosis, high cholesterol, cardiovascular disease acute pancreatitis and skin lesions. All these symptoms are associated with poor blood health and may be the reason for medicating with a blood purifier. Although studies (see review by (Mollazadeh et al., 2018) have been undertaken on medicinal plants to treat hypertriglyceridemia, no attention has been given to the plant species as indicated in Table 2. Another study of importance that should be investigated is the role of these medicinal plants in blood thinning. Well-known spices such as turmeric and ginger are esteemed for their blood thinning properties, and studies on Chinese herbs (Xi and Gong, 2017) have been given some attention, yet no studies have been undertaken on the plants indicated herein as blood purifiers. The commercial counterpart Warfarin has major side effects that include severe bleeding, severe headaches, stomach pain, joint pain, vomiting of blood, bruising etc. A 49

natural alternative with less harsh side effects may be the answer, yet this area of research has been poorly studied on a global scale, none the less on the medicinal plants indicated here as blood purifiers. It is clear that blood purification is associated with a holistic health status, and this is supported with the inclusion of common food plants such as Citru limon (lemon) and Cucurbita pepo (pumpkin). Furthermore, selected plant species (C. leptophylla, G. croucheri, H. fasciata, H. enneaspermus. P. camphorate, Z. capense and Z. mucronata) were additionally noted for their use a tonic. While tonic plants of southern Africa have been studied (Olivier and van Wyk, 2013), the link to blood purification has been neglected and could be further explored. In line with overall health, the possibility of these plant species to act as immunomodulators is a distinct possibility. Such studies have been undertaken on B. pilosa and H. hemerocallidea (Abajo et al., 2004; Ncube et al., 2013), but studies should be extended to other plant species such as D. basuticus specifically indicated as an immune system booster. Of the 159 species identified, there were 41 species (26%) for which no positive health-related research existed (Table 2). There is a strong link between blood purification plants and their use as a purgative or laxative. While there has been some pharmacological studies on gastrointestinal motility on the Aloe spp. (Celestino et al., 2013), no attention has been given to H. enneaspermus and R. crispus specifically indicated for laxative use. Many studies have focused on southern African plant species and their ability to act as antidiarrheal’s (van Vuuren and Holl, 2017), but in this case it would be beneficial to determine gastrointestinal motility with the perspective of purging rather than prevention. Such actions, however, may be linked to cytotoxicity and dose response studies are needed to be investigated in tandem. While plant combinations have been given some attention in this review, the combined use of medicinal plants with allopathic medicines does warrant some caution. As these may be given as a general “tonic” or “immune booster” the use in conjunction with prescribed medicines may cause adverse drug interactions. While herb-drug interactions have been studied quite extensively with numerous reviews (Zhou et al., 2007; Bo et al., 2016; Byeon et al., 2019), very little attention has been given to South African medicinal plants and the interactions they may have on allopathic medicines. A review by Kamsu-Foguem and Foguem (2014), provides some insight into these possible interactions. More specifically, the antimicrobial role of synergy and antagonism into Southern African popular medicinal plant species with commercial antibiotics has been given some attention (Hübsch et al., 2014a; 2014b), but, more studies are needed to investigate this subject matter. 50

7.2. The link between African blood purification concepts and westernised principles What is very clear from examining all the studies herein is that very little attention has been given to scientifically validating the pharmacological activity specifically with the focus on blood purification as defined in the westernized concept. Blood purification from an African concept is seldom used independently and has strong correlations with traditional African rituals and religion (Cumes, 2013; White, 2015). The westernized concept of blood purification specifically deals with exact scientific principles and there is a plethora of reviews (Chan et al., 2013; Pu et al., 2013; Ju et al., 2019) of how these principles can be improved for a better health outcome. It is important to note that westernized concepts of blood purification may rely on sophisticated medical equipment not accessible to traditional healers. Furthermore, it is highly unlikely that traditional healers would even consider such methods as it goes against the principle of traditional concepts. Until such time that the African concept of blood purification is understood, further correlation between the two is inconceivable. Researchers delving into traditional use should be asking the questions “why is a blood purifier used?” and not just which plant species are used. It is conceivable that understanding this aspect can lead to more directives that would validate the westernized concept of blood purification. Certainly antimicrobial properties, immune boosters, laxative effects and blood thinning assays are explored by both westernized medicinal treatments and African healers. Thus, this should be the first starting point for further investigation.

8.

Concluding comments

On examination of the plant species indicated for blood purification, it can be reasonably assumed that categorization as a southern African blood purifier may imply a holistic approach ranging from an anti-infective effect, increased gastrointestinal motility to immunomodulation amongst various other health benefits. While these and other pharmacological studies have been undertaken sporadically, there has been no concerted effort to collate and correlate the overall health benefits and link this to blood cleansing. Selected plant species with scientific reviews are beneficial in this respect and have been undertaken on a few plant species, however, for the majority of the species, valuable studies such as blood thinning could add value. Of the 41 species for which no research evidence exists, six species (M. dregeanus, I. albivenia, A. stipulaceaare, G. cuneata, C. zeyheriana, and R. lanceolatus) is of particular interest and may warrant pioneering research investment 51

as these have more than one citation which links use to that of a blood purifier. Furthermore, A. stenophylla has an array of uses similar to A. senegalensis, which could be comparatively investigated, as with other species of the same genus. From the lack of studies in this field, it is quite clear that this area of blood purification research is lacking and just examining the plant species in Table 2 will give researchers a good starting point with which to examine this field in greater depth.

Funding

No funding was required for this research.

Author contribution

S. van Vuuren- conceptualized study, wrote manuscript. L. Frank-sourced information and wrote initial drafts of manuscript.

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