1 By: MOSES CHARIKAR, CHANDRA CHEKURI, TOMAS FEDER, AND RAJEEV MOTWANI Presented By: Sarah Hegab.
Ethnogynaecological Assessment of Medicinal Plants in ... · 2 BioMedResearchInternational...
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Research ArticleEthnogynaecological Assessment of Medicinal Plants inPashtunrsquos Tribal Society
Muhammad Adnan1 Akash Tariq1 Sakina Mussarat1 Shaheen Begum2
Naser M AbdEIsalam3 and Riaz Ullah4
1Department of Botany Kohat University of Science and Technology Kohat 26000 Pakistan2Department of Environmental Sciences Fatima Jinnah Women University The Mall Rawalpindi Punjab 46000 Pakistan3Riyadh Community College King Saud University Riyadh 11437 Saudi Arabia4Department of Chemistry Government College Ara Khel Frontier Region Kohat 26000 Pakistan
Correspondence should be addressed to Akash Tariq akashmalik786yahoocom
Received 23 September 2014 Accepted 3 December 2014
Academic Editor Gail B Mahady
Copyright copy 2015 Muhammad Adnan et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited
The present study was designed to document detailed ethnogynaecological knowledge of selected remote regions of Pashtunrsquos tribein northwest Pakistan Semistructured questionnaires were designed to collect ethnogynaecological and ethnographic data Totalof 51 medicinal plants belonging to 36 families were documented that were used by the women of studied regions for the treatmentof 9 types of gynaecological complaints Majority of the plants (19) were found used against menses followed by 11 plants each forgonorrhea and pregnancy Bannu region has high number of gynaecological plants (22) followed by Karak (15) Women of theregions mostly used whole plants (33) and leaves (31) for various ethnomedicinal preparation of gynae Fic results showed thatall ailments in different areas scored high consensus ranges between 06 and 100 Majority of the female respondents (44) wereaged between 61 and 70 years of which most were illiterate Women in the remote regions of Pakistan have tremendous traditionalknowledge in utilizing medicinal plants for their reproductive health Plants with high Fic values should be cross-checked for theirin vitro and in vivo validation Young girls should be educated on the importance of ethnogynaecological practices to conserve thisvaluable knowledge
1 Introduction
Medicinal plants are always an essential part of human healthcare system because there are major concerns about syn-thetic drugsrsquo expensiveness side effects and toxicity WHOreported that almost three-fourths of the world populationrely on traditional medicines [1] In the present time it isvery much essential to find some alternative medicines forthe treatment of variety of ailments [2] More than 50 ofall modern clinical or allopathic drugs are of natural productorigin hence traditional medicines can play a vital role inthe pharmaceutical sciences [3] Pakistan is bestowed witha great diversity of medicinal plants Out of 6000 floweringplant species in Pakistan 600 species were reported for theirmedicinal uses [4]
Gynaecology is the medical treatment of female repro-ductive system (uterus vagina and ovaries) health Ethnogy-naecology is an emerging newbranch that basically deals withthe healing of ailments among tribal women for exampleabortion menstrual trouble leucorrhoea antifertility anddelivery problems [5] Sexual and reproductive health prob-lems account for 18 of the total global burden of diseaseand 32 of the burden among women of reproductive age[6] Women in the remote areas of Pakistan depend onthe plants for curing various diseases including abortionantifertility leucorrhoea and other menstrual troubles Theydo not go to doctor rather they depend on herbal treatmentas per the suggestions of old women or traditional healers[7] Rural women of Pakistan are frequently experiencinggynaecological problems and are more susceptible due to
Hindawi Publishing CorporationBioMed Research InternationalVolume 2015 Article ID 196475 9 pageshttpdxdoiorg1011552015196475
2 BioMed Research International
Afghanistan
Charikar
Jalalabad
Khyber Agency
Kabul
Gardeyz
Khowst
SharZarghun North
SouthWaziristan
Balochistan
WaziristanRazmak
Miranshah
Wana
Jandola
LakkiMarwat
Tank
Zhob
Dera IsmailKhan
DeraKhanIsmail
BannuKarak
HanguKurramAgency
ParachinarLandi
MohmandAgency
KotalOrakzai Agency
KohatKohat
Mianwali
Kalabagh
Panjab
Pakistan
Islamabad
Murree
India
BajaurAgency
DirDir
SwatShangla
Battagram
Mansehra
Mansehra
Chitral
Chitral
Mastuj
Mt Tirichmir Mor Khun
Northern Areas
Gilgit
AgencyMalakand
NowsheraCharsadda
Peshawar
Mardan Swabi
Buner
HaripurAbbottabad
Tajikistan
Kalam DasuKohistan
SaiduSharif
Naran
Figure 1 Map of the study area
poor standard of living famine and hard physical work evenduring their pregnancy Women locally known as ldquoDaiyardquohave tremendous traditional knowledge for the treatment ofthese diseases utilizing medicinal plants [8] However thisknowledge is decreasing rapidly as younger generation istaking least interest in learning these valuable practices andhealing techniques
In Pakistan there are very few studies conducted purelyon ethnogynaecology Literature is very scarce regardingtraditional medicines used by rural women for the treatmentof gynaecological disorders The present study was thereforedesigned to document traditional plants and their gynaeco-logical uses in the six major areas of Khyber PakhtunkhwaProvince Pakistan These regions are dominated by Pash-tunrsquos tribe and remote with poor infrastructure and lack ofmodern facilities People of the regions have low incomestatus and are suffering from high level of poverty [9ndash12]These factors force the locals to use traditional medicineand keep the indigenous knowledge intact The presentresearch was therefore designed with the aim to documentethnogynaecological knowledge of plant resources and toselect candidate plants for further in vitro investigationsThe present research would be a great contribution at both
national and international level for the use of traditionalplants against gynaecological problemsThe present researchwill provide baseline information for future research studiesregarding phytochemistry pharmacology and conservationof gynaecological plants
2 Materials and Methods
21 Study Area The present study was conducted in sixremote areas (Bannu Kohat Karak Malakand Mansehraand Chitral) of Khyber Pakhtunkhwa (KPK) Province Pak-istan (Figure 1) Bannu region is located in the south of KPKprovince and consists of 877Km2 area with a population of19593 [9] It lies between 32∘-43 and 33∘-06N latitude and 73∘-20 and 70∘-07E longitude Karak is situated in the south ofprovince with a total area of 600 km2 and lies between 70-40∘and 71-30∘N latitude and 32-48∘ and 33-23∘E longitude [10]Kohat is located at 33∘35101584013N 71∘26101584029E with an altitude of489m asl [13] Malakand is located in the north of KPKbetween 35∘10 and 35∘16N latitude and 71∘50 and 71∘83E lon-gitude [11] Chitral is the largest district of KPK province with14850 km2 area and lies between 35∘1510158400610158401015840 and 36∘5510158403210158401015840N
BioMed Research International 3
latitude and 71∘1110158403210158401015840 and 73∘5110158403410158401015840E longitude with a popu-lation of about 320000 [14] Mansehra is located at 34∘201015840N73∘121015840E of KPK a province Majority of the population inthe study regions are dominated by the Pashtunrsquos ethnicgroup All the regions are rural in nature and women ofthe regions are greatly dependent upon medicinal plants andforest resources for their primary health care need and forimproving their livelihood
22 Sampling and Data Collection Data of present study wasdocumented from January 2014 to June 2014 Prior to datacollection a brief group discussion was held with the rep-resentatives (Sherin Zaman Faiz Ullah Khan and NazirKhan) of communities locally known as ldquoMalikrdquo in order togain their consent to explain objectives of the researchstudy and to assure them protection of their traditionalknowledge The selection of informants was mainly based ontheir rich indigenous knowledge and long term experience ofutilization of plants Total of 300 female respondents wereselected in six regions with 50 informants in each area Lessnumber of informant selections in each area is due to thereason of cultural and religious restrictions of females Theselected respondents were local inhabitants of the regionsaged between 40 and 80 years Data was collected in the locallanguage of the respondents and then converted into EnglishSemistructured questionnaires were designed to collect eth-nomedicinal and ethnographic data The informants wereasked about the number of gynaecological plants known tothem their gynaecological applications and their parts usedEthnographic data about the age occupation and educationof the informants were also collected All the respondents andfocal persons of the study area provided permission to publishand protect the data on traditional medicines provided bythem
23 Specimen Collection and Identification Plants docu-mented by key respondents were collected from home gar-dens and natural vegetation during field surveyThe collectedvoucher specimens were taken to the Herbarium of KohatUniversity of Science and Technology (KUST) Kohat Pak-istan
Specimen identification and confirmation were under-taken by using Flora of Pakistan and taxonomic expertsSpecimens with their label were stored at the Herbarium ofKUST
24 Data Organization The collected data on ethnogy-naecological plants and ethnography of the respondentswas organized using Microsoft Excel 2007 and summarizedusing graphical statistical methods such as percentages Thehabit of the plants was categorized into 3 classes (herbsshrubs and trees) Reproduction of medicinal plants wasclassified into annual biennial and perennial Plant partswere classified into leaves roots stem whole plant seedsfruit and flower Gynaecological disorders were dividedinto 9 categories that is menses gonorrhea leucorrhoeaabortion pregnancy gynae abortifacient female impotencyand mastitis Ages of the respondents were categorized into
0
5
10
15
20
25
Bannu Karak Malakand Mansehra Chitral Kohat
Number of plantsNumber of gynaecological problems
Figure 2 Number of plants and gynaecological problems treated indifferent regions of Pakistan
four groups (40ndash50 51ndash60 61ndash70 and 71ndash80) Education ofthe female respondents was classified into 5 classes that isilliterate primary middle secondary and university level ofeducation Occupation of the females was divided into onlytwo classes (housewives and teachers)
25 Data Analysis
251 Informant Consensus Factor (Fic) Fic was used to forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and thus aids in the selection of plantsfor pharmacological and phytochemical studies [15] Prior tousing this method illnesses were classified into categoriesas high Fic plants are likely to be more pharmacologicallyactive in comparison with low Fic value plants [16] Fic valueslie between ldquo000 and 100rdquo Fic values are always greaterwhen single plant or few plants are used by large number ofinformants to cure a specific disorder while low Fic valuesgive an indication that informants do not agree over whichplant to use [17 18] The Fic can be calculated using theformula as follows
Fic = nur minus ntnur minus 1
(1)
where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used
3 Results
The present study revealed that women of studied regionsused about 51 plants belonging to 36 families (Table 1) Bannuregion was found with high number of gynaecological plants(22) followed by Karak (15) Malakand (14) Mansehra (11)Chitral (10) and Kohat (8) Nine types of diseases weretreated in Bannu followed by eight in Karak (Figure 2)Women of the regions mostly used herbs (59) for thepreparation of ethnomedicines followed by trees (266)(Table 2) It was found that majority of the plants (78)were perennial in their mode of reproduction Women of the
4 BioMed Research International
Table1Ethn
omedicinalplantsused
totre
atgynecologicalproblem
s
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Acanthaceae
Justicia
adhatoda
LKU
H-810
Baikar
Shrub
Perenn
ial
Rootleaves
MalakandKa
rak
Bann
uGyn
aeabo
rtifa
cient
Amaranthaceae
Achyranthesa
speraLKU
H-811
Kurshaka
Herb
Perenn
ial
Who
leplant
KohatMalakand
Gon
orrhea
Anacardiaceae
Schinu
smolleLKU
H-812
Toor
maruch
Tree
Perenn
ial
Barkleaffruits
Bann
uMenses
Amaryllid
aceae
Alliu
msativ
umLKU
H-813
Thom
aHerb
Perenn
ial
Seeds
Karak
Menses
Alliu
mcepa
LKU
H-814
Thrashto
Herb
Perenn
ial
Bulb
Chitral
Gyn
aem
enses
Brassic
aceae
Brassicacampestr
isLKU
H-815
Sarson
Herb
Ann
ual
Leaves
MalakandKo
hat
Karak
Mastitis
Sisymbrium
irioLKU
H-816
Khelik
heli
Herb
Ann
ual
Seeds
ChitralK
arakB
annu
Pregnancy
Cann
abaceae
Cann
abissativaLKU
H-817
Bang
aHerb
Ann
ual
Leaves
andbark
Bann
uMalakand
Mansehra
Gon
orrheapregn
ancy
Cela
straceae
Gymnosporiaroyleana
Wallex
MAL
awsonKU
H-818
Pataki
Shrub
Perenn
ial
Seed
MansehraKa
rak
Pregnancy
Con
volvulaceae
Convolvulusa
rvensis
LKU
H-819
Pryvatay
Herb
Perenn
ial
Who
leplant
KarakBa
nnu
MalakandKo
hat
Menses
Cucurbita
ceae
Citru
lluscolocynthis(L)Schrad
KUH-820
Maraginyetr
uhHerb
Perenn
ial
Rootsa
ndfruits
Bann
uAb
ortifacientm
astitis
Cyperaceae
Cyperusrotun
dusL
KUH-821
Delloca
Herb
Perenn
ial
Who
leplant
Bann
uMenses
Equisetaceae
Equisetum
ramosissim
umDesf
KUH-822
Jorterhorse
tail
Herb
Perenn
ial
Who
leplant
Mansehra
Gon
orrhea
Fabaceae
Acaciafarnesiana
(L)Willd
KUH-823
Vilayatikikar
Tree
Perenn
ial
Gum
Kohat
Leucorrhoea
Acaciamodesta
WallKU
H-824
Palosa
Tree
Perenn
ial
Who
leplant
KohatKa
rakBa
nnu
Mansehra
Gon
orrheagyn
ae
Acacianilotica(L)Willdex
DelileKU
H-825
Kikar
Tree
Perenn
ial
Leavesbarkpo
dBa
nnuKa
rak
Mansehra
Gyn
aegon
orrhea
leucorrheafem
ale
impo
tency
Medica
gosativaLKU
H-826
Malkind
yeHerb
Perenn
ial
Leavesstem
Bann
uMenses
LotuscorniculatusL
KUH-827
Rub
Herb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Hypericaceae
Hypericu
mperfo
ratum
LKU
H-828
Sheenchai
Herb
Perenn
ial
Fruitshoo
tMalakand
Menses
Juglandaceae
Jugla
nsregiaLKU
H-829
Ghu
zTree
Perenn
ial
Bark
KohatMansehra
Gyn
ae
Juncaceae
Juncus
thom
soniiB
uchenau
KUH-830
Gaw
agHerb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Lamiaceae
Menthavirid
is(L)LKU
H-831
Podina
Herb
Perenn
ial
Leaves
Malakand
Menses
Thym
usserpyllum
LKU
H-832
Mervezei
Herb
Perenn
ial
Who
leplant
Bann
uMensesgynae
Malvaceae
Abelm
oschus
esculen
tus(L)
MoenchKU
H-833
Bhindi
Herb
Ann
ual
Fruits
Karak
Gon
orrhea
Abutilonindicum
(L)Sw
eet
KUH-834
Koso
beta
Shrub
Ann
ual
Who
leplant
Bann
uLeucorrhoeagynae
gono
rrheaabortio
nMalva
parvifloraLKU
H-835
Tikalai
Herb
Ann
ual
Leaves
Bann
uMenses
BioMed Research International 5
Table1Con
tinued
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Meliaceae
Meliaazadira
chta
LKU
H-836
Bakana
Tree
Perenn
ial
Barkfruits
gum
Bann
uKa
rak
Gon
orrhea
Myrtaceae
Eucalyptus
globu
lusL
abill
KUH-837
Lachi
Tree
Perenn
ial
Leavesoilste
mMalakand
Menses
Nyctaginaceae
Boerhaviacoccinea
Mill
KUH-838
Insutp
unara
Herb
Perenn
ial
Who
leplant
Malakand
Menses
Oleaceae
Olea
ferrugineaRo
yleK
UH-839
Khu
naTree
Perenn
ial
Fruits
leaves
Malakand
Menses
Fraxinus
xanthoxyloides(G
Don
)AD
CKU
H-840
Toor
Herb
Perenn
ial
Barkstemleaves
Chitral
Gyn
ae
Papaveraceae
Papaversom
nifer
umLKU
H-841
Posat
Herb
Ann
ual
Flow
erfruit
Mansehra
Abortifacientpregn
ancy
Plum
baginaceae
Plum
bago
zeylanica
LKU
H-842
Chmchip
attar
Shrub
Perenn
ial
Root
Mansehra
Abortifacient
Plantaginaceae
Veronica
agrestisL
KUH-843
Kho
sobeta
Herb
Ann
ual
Who
leplant
Bann
uMensespregnancy
Poaceae
Arun
dodona
xLKU
H-844
Herb
Perenn
ial
Stem
rhizome
Bann
uMenses
Desmostachya
bipinn
ata(L)
StapfK
UH-845
Gharc
hichon
aGrass
Perenn
ial
Who
leplant
Karak
Menses
Polygonaceae
Polyg
onum
biaristatum
Aitchamp
Hem
slKU
H-846
How
arSh
rub
Perenn
ial
Who
leplant
Bann
uGon
orrhea
Ranu
nculaceae
Aconitu
mheterophyllum
Wallex
RoyleK
UH-847
Patris
bhangdewana
sarbaw
ali
Herb
Perenn
ial
Latexroot
Mansehra
Gyn
ae
Rham
naceae
Zizip
husm
auritiana
Lam
KUH-848
Bera
Tree
Perenn
ial
Leavesbarkseeds
Bann
uGyn
ae
Rosaceae
Crataegussongaric
aK
Koch
KUH-849
Gho
nii
Tree
Perenn
ial
Leavesstembark
Chitral
Gyn
ae
Rubiaceae
Rand
iatetra
spermaBe
nthamp
Hoo
kfKU
H-850
Mainp
hal
Shrub
Perenn
ial
fruit
Chitral
Abortifacient
Rutaceae
Zanthoxylum
armatum
DC
KUH-851
Timbar
Tree
Perenn
ial
Fruitleaves
Mansehra
Abortifacient
Salicaceae
Salix
acmophylla
BoissK
UH-852
Chekar
Herb
Perenn
ial
Leavestwigs
Chitral
Menses
Saxifragaceae
Bergeniastracheyi(H
ookfamp
Thom
son)
EnglK
UH-853
Bisabu
rHerb
Perenn
ial
Leavesroo
tslatex
Chitral
Pregnancy
Solanaceae
Hyoscyamus
nigerL
KUH-854
Joligao
Herb
Biennial
Leaves
Chitral
Pregnancy
Solanu
msuratte
nseB
urmf
KUH-855
Manragh
onaym
ahok
riHerb
Biennial
Who
leplant
MalakandBa
nnu
Kohat
Gon
orrheapregn
ancy
With
aniacoagulan
s(Stocks)
Dun
alKU
H-856
Panirpanird
oda
Herb
Ann
ual
Fruits
KohatKa
rakBa
nnu
Leucorrhoea
With
aniasomnifer
a(L)Dun
alKU
H-857
Kotilaljanglip
aneer
Shrub
Perenn
ial
Who
leplant
MalakandMansehra
KarakBa
nnu
Leucorrheafem
ale
impo
tencymenses
DaturametelLKU
H-858
Barbaka
Shrub
Perenn
ial
Who
leplant
KarakBa
nnu
Gon
orrhea
Tamaricaceae
Tamarixaphylla
(L)HK
arst
KUH-859
Sheengh
azz
Tree
Perenn
ial
Leavesbark
KarakBa
nnu
Gyn
ae
Verbenaceae
Verbenaoffi
cinalisLKU
H-860
Koso
beeta
Herb
Perenn
ial
Who
leplant
Bann
uMalakand
Pregnancymenses
6 BioMed Research International
Table 2 General attributes of medicinal plants
Attribute Total number Percentage ()Part use
Leaves 16 313Whole plant 17 333Fruit 10 192Bark 6 115Root 5 96Stem 4 76Seed 4 76Flower 1 19
HabitHerb 31 59Shrub 7 134Trees 14 269
ReproductionAnnual 9 173Biennial 2 38Perennial 41 788
02468
101214161820
Num
ber o
f pla
nts
Abor
tion
Impo
tenc
y
Mas
titis
Leuc
orrh
oea
Abor
tifac
ient
Gyn
ae
Preg
nanc
y
Gon
orrh
ea
Men
ses
Gynaecological problems
Figure 3 Number of plants used to treat gynaecological problems
regions used different plant parts for the recipe preparationbut whole plant and leaves (33 and 31 resp) were foundto be the most frequent parts used against gynaecologicalcomplaints (Table 2) Nine types of gynaecological ailmentswere treated in study areas Majority of the plants (19) werefound to be used against menses followed by 11 plants eachfor gonorrhea and pregnancy related problems (Figure 3) Ficresults showed that all plants in different areas scored highconsensus ranges between 06 and 100 (Table 3) Majorityof the female respondents (44) were aged between 61 and70 years Total of 40 informants were illiterate followed by38 who had just primary level of education Majority of thefemales (86) interviewed were housewives followed by 14school teachers (Table 4)
4 Discussion
Present study results showed that women of studied remoteareas of Pakistan have strong traditional knowledge in theutilization of medicinal plants for variety of gynaecologi-cal disorders Traditionally the rural women prefer plantmedicines rather than modern medicine for their personalailments due to lack of modern facilities in the regionsAmong all studied regions Bannu was ranked first havinglarge number of gynaecological plants High number ofmedicinal plants in the region might be associated withthe prevalence of large number of gynaecological problemsin the Bannu region Nine types of ailments were foundtreated using ethnomedicines in Bannu region It is a waraffected region of Pakistan where traditional medicines useis a common practice [9] Karak and Malakand regions alsocontain considerable number of gynaecological plants due tothe greater plant diversity in the regions rural nature anddependency of women for their primary health care needs[11 19]
The women of the studied regions mostly use herbs(59) for the preparation of ethnomedicines followed bytrees (269) In most remote areas medicinal herbs arethe main ingredients of local medicines and consideredthe main lifeline and frequently first choice The highestuse of herbs gives an indication of the presence of greatabundance of herb species as noticed during field visits thatareas very close to houses were well covered with herbs andcenturies old traditional knowledge of the healers Commonuse of herbaceous plants has also been reported from otherregions of Pakistan [2 20] and parts of the world [21 22]Herbs can grow in variety of places like roadsides homegardens farmland wild habitats and foundmore common incomparison to other growth forms The highest tree speciesutilization might be associated with their potential to surviveeven during long dry seasons thus their abundance andavailability throughout the year is higher in arid and semiaridareas The findings are in line with some studies [10 23]while being contradictory with studies conducted elsewherewhere shrubs were more frequently used [24 25] Variationin medicinal plants growth form might be associated withdifferent sociocultural beliefs ecological status and variationin practices of traditional healers of different regions orcountries Women mostly use perennial plants (78) for thetreatment of gynaecological problems The reason behindusing perennial plants might be due to the fact that highnumber of herbs and trees in the studied regions are perennialin their reproduction status
Women of studied regions use reported medicinal plantsfor the treatment of nine types of gynaecological ailmentsMenses was found to be the most treated ailment in thestudied regions Total of 19 plants were used to treat mensesrelated problems followed by 11 plants each for gonorrhea andpregnancy 10 for gynae 6 for abortifacient 5 for leucorrheaand 2 plants each for mastitis and impotency and singleplant is used for abortion Higher plant utilization for mensesmight be due to natural phenomenon associated with varietyof complications such as abdominal or pelvic cramping
BioMed Research International 7
Table 3 Fic values of traditional medicinal plants for treating gynaecological problems in study regions
Gynaecological problems Bannu Karak Kohat Chitral Mansehra MalakandMenses 088 091 100 087 mdash 097Gonorrhea 091 093 083 mdash 092 092Mastitis 100 100 100 mdash mdash 100Pregnancy 094 081 mdash 090 072 072Leucorrhoea 091 096 082 mdash 092 100Abortion 100 mdash mdash mdash mdash mdashGynae 082 052 075 072 063 061Female impotency 091 093 mdash mdash 100 100
Table 4 Ethnographic data of study regions
Ethnographic characters Bannu Karak Malakand Chitral Mansehra Kohat PercentageAge groups
40ndash50 6 5 7 4 5 4 1051ndash60 15 12 13 12 10 10 2461ndash70 20 22 21 23 20 26 4471ndash80 9 11 9 11 15 10 22
EducationIlliterate 22 19 23 17 19 20 40Primary 18 22 20 14 19 19 38Middle 5 6 2 9 6 6 11Secondary 3 2 3 6 4 4 7University 2 1 2 4 2 1 4
OccupationHousewives 43 39 46 47 41 43 86Teachers 7 11 4 3 9 7 14
lower back pain bloating and sore breasts food cravingsmood swings and irritability headache and fatigue [2627] Different plants have been found effective in relievingmenses complications like Justicia adhatoda Schinus molleConvolvulus arvensis Cyperus rotundus and Hypericum per-foratum Rural women use different parts of plant to prepareethnomedicines however use of specific plant part dependsupon plant habit and user requirements Traditional healersmostly prefer leaves and whole plant for the formulation ofgynaecological recipes The selection of specific plant partssuggests that these parts have strong healing potential againstgynaecological disorders but these parts need phytochemicalscreening and pharmacological investigation in order tocross-check traditional knowledge Present findings are inline with other studies showing leaves and whole plants asthe most frequently used plant parts for the preparation ofdifferent ethnomedicines [21 22 28] Whole plant harvestingis considered a destructive type of harvesting and causespopulation reduction of plant species
Most of the plants were found used in more than oneregion for the same particular ailment for example Con-volvulus arvensis was used against menses complication inBannu Kohat Karak and Malakand Melia azadirachta wasfound to be effective against gonorrhea in Bannu and KarakSolanum surattense was being used against gonorrhea andpregnancy in Malakand Bannu and Kohat Such types of
resemblance using similar plants for the same type of ailmentsin different cultures or regions provide a strong signal ofbioactivity potential of the documented plant species Infor-mant consensus results showed high consensus values rangesbetween 06 and 100 for 9 disease categories in different areasHigh Fic values in these regions indicate high prevalence ofgiven gynaecological problems in these regions Accordingto Heinrich et al [17] high Fic values are very useful inthe selection of specific plants for further search of bioactivecompounds Most of the diseases were found to be treatedwith only one or two plants in the studied regions and theirFic score was also high 100 Such plants should furtherbe analyzed for their phytochemical and pharmacologicalinvestigation
Ethnographic data showed that majority of the females(44) interviewed were aged between 61 and 70 years Theseresults clearly indicate that traditional knowledge is restrictedto aged people in these regions due to least interest ofyounger generation Total of 40 informants were illiteratein these regions followed by 38 who had only primary levelof education Only 4 respondents had university level ofeducation which reflects the unavailability of standard edu-cational institutions in these areas Literate people had lessknowledge about medicinal plants as compared to illiteratepeople of the regions due to modernization and changing lifestyles Total of 86 women were housewives while only 14
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
2 BioMed Research International
Afghanistan
Charikar
Jalalabad
Khyber Agency
Kabul
Gardeyz
Khowst
SharZarghun North
SouthWaziristan
Balochistan
WaziristanRazmak
Miranshah
Wana
Jandola
LakkiMarwat
Tank
Zhob
Dera IsmailKhan
DeraKhanIsmail
BannuKarak
HanguKurramAgency
ParachinarLandi
MohmandAgency
KotalOrakzai Agency
KohatKohat
Mianwali
Kalabagh
Panjab
Pakistan
Islamabad
Murree
India
BajaurAgency
DirDir
SwatShangla
Battagram
Mansehra
Mansehra
Chitral
Chitral
Mastuj
Mt Tirichmir Mor Khun
Northern Areas
Gilgit
AgencyMalakand
NowsheraCharsadda
Peshawar
Mardan Swabi
Buner
HaripurAbbottabad
Tajikistan
Kalam DasuKohistan
SaiduSharif
Naran
Figure 1 Map of the study area
poor standard of living famine and hard physical work evenduring their pregnancy Women locally known as ldquoDaiyardquohave tremendous traditional knowledge for the treatment ofthese diseases utilizing medicinal plants [8] However thisknowledge is decreasing rapidly as younger generation istaking least interest in learning these valuable practices andhealing techniques
In Pakistan there are very few studies conducted purelyon ethnogynaecology Literature is very scarce regardingtraditional medicines used by rural women for the treatmentof gynaecological disorders The present study was thereforedesigned to document traditional plants and their gynaeco-logical uses in the six major areas of Khyber PakhtunkhwaProvince Pakistan These regions are dominated by Pash-tunrsquos tribe and remote with poor infrastructure and lack ofmodern facilities People of the regions have low incomestatus and are suffering from high level of poverty [9ndash12]These factors force the locals to use traditional medicineand keep the indigenous knowledge intact The presentresearch was therefore designed with the aim to documentethnogynaecological knowledge of plant resources and toselect candidate plants for further in vitro investigationsThe present research would be a great contribution at both
national and international level for the use of traditionalplants against gynaecological problemsThe present researchwill provide baseline information for future research studiesregarding phytochemistry pharmacology and conservationof gynaecological plants
2 Materials and Methods
21 Study Area The present study was conducted in sixremote areas (Bannu Kohat Karak Malakand Mansehraand Chitral) of Khyber Pakhtunkhwa (KPK) Province Pak-istan (Figure 1) Bannu region is located in the south of KPKprovince and consists of 877Km2 area with a population of19593 [9] It lies between 32∘-43 and 33∘-06N latitude and 73∘-20 and 70∘-07E longitude Karak is situated in the south ofprovince with a total area of 600 km2 and lies between 70-40∘and 71-30∘N latitude and 32-48∘ and 33-23∘E longitude [10]Kohat is located at 33∘35101584013N 71∘26101584029E with an altitude of489m asl [13] Malakand is located in the north of KPKbetween 35∘10 and 35∘16N latitude and 71∘50 and 71∘83E lon-gitude [11] Chitral is the largest district of KPK province with14850 km2 area and lies between 35∘1510158400610158401015840 and 36∘5510158403210158401015840N
BioMed Research International 3
latitude and 71∘1110158403210158401015840 and 73∘5110158403410158401015840E longitude with a popu-lation of about 320000 [14] Mansehra is located at 34∘201015840N73∘121015840E of KPK a province Majority of the population inthe study regions are dominated by the Pashtunrsquos ethnicgroup All the regions are rural in nature and women ofthe regions are greatly dependent upon medicinal plants andforest resources for their primary health care need and forimproving their livelihood
22 Sampling and Data Collection Data of present study wasdocumented from January 2014 to June 2014 Prior to datacollection a brief group discussion was held with the rep-resentatives (Sherin Zaman Faiz Ullah Khan and NazirKhan) of communities locally known as ldquoMalikrdquo in order togain their consent to explain objectives of the researchstudy and to assure them protection of their traditionalknowledge The selection of informants was mainly based ontheir rich indigenous knowledge and long term experience ofutilization of plants Total of 300 female respondents wereselected in six regions with 50 informants in each area Lessnumber of informant selections in each area is due to thereason of cultural and religious restrictions of females Theselected respondents were local inhabitants of the regionsaged between 40 and 80 years Data was collected in the locallanguage of the respondents and then converted into EnglishSemistructured questionnaires were designed to collect eth-nomedicinal and ethnographic data The informants wereasked about the number of gynaecological plants known tothem their gynaecological applications and their parts usedEthnographic data about the age occupation and educationof the informants were also collected All the respondents andfocal persons of the study area provided permission to publishand protect the data on traditional medicines provided bythem
23 Specimen Collection and Identification Plants docu-mented by key respondents were collected from home gar-dens and natural vegetation during field surveyThe collectedvoucher specimens were taken to the Herbarium of KohatUniversity of Science and Technology (KUST) Kohat Pak-istan
Specimen identification and confirmation were under-taken by using Flora of Pakistan and taxonomic expertsSpecimens with their label were stored at the Herbarium ofKUST
24 Data Organization The collected data on ethnogy-naecological plants and ethnography of the respondentswas organized using Microsoft Excel 2007 and summarizedusing graphical statistical methods such as percentages Thehabit of the plants was categorized into 3 classes (herbsshrubs and trees) Reproduction of medicinal plants wasclassified into annual biennial and perennial Plant partswere classified into leaves roots stem whole plant seedsfruit and flower Gynaecological disorders were dividedinto 9 categories that is menses gonorrhea leucorrhoeaabortion pregnancy gynae abortifacient female impotencyand mastitis Ages of the respondents were categorized into
0
5
10
15
20
25
Bannu Karak Malakand Mansehra Chitral Kohat
Number of plantsNumber of gynaecological problems
Figure 2 Number of plants and gynaecological problems treated indifferent regions of Pakistan
four groups (40ndash50 51ndash60 61ndash70 and 71ndash80) Education ofthe female respondents was classified into 5 classes that isilliterate primary middle secondary and university level ofeducation Occupation of the females was divided into onlytwo classes (housewives and teachers)
25 Data Analysis
251 Informant Consensus Factor (Fic) Fic was used to forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and thus aids in the selection of plantsfor pharmacological and phytochemical studies [15] Prior tousing this method illnesses were classified into categoriesas high Fic plants are likely to be more pharmacologicallyactive in comparison with low Fic value plants [16] Fic valueslie between ldquo000 and 100rdquo Fic values are always greaterwhen single plant or few plants are used by large number ofinformants to cure a specific disorder while low Fic valuesgive an indication that informants do not agree over whichplant to use [17 18] The Fic can be calculated using theformula as follows
Fic = nur minus ntnur minus 1
(1)
where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used
3 Results
The present study revealed that women of studied regionsused about 51 plants belonging to 36 families (Table 1) Bannuregion was found with high number of gynaecological plants(22) followed by Karak (15) Malakand (14) Mansehra (11)Chitral (10) and Kohat (8) Nine types of diseases weretreated in Bannu followed by eight in Karak (Figure 2)Women of the regions mostly used herbs (59) for thepreparation of ethnomedicines followed by trees (266)(Table 2) It was found that majority of the plants (78)were perennial in their mode of reproduction Women of the
4 BioMed Research International
Table1Ethn
omedicinalplantsused
totre
atgynecologicalproblem
s
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Acanthaceae
Justicia
adhatoda
LKU
H-810
Baikar
Shrub
Perenn
ial
Rootleaves
MalakandKa
rak
Bann
uGyn
aeabo
rtifa
cient
Amaranthaceae
Achyranthesa
speraLKU
H-811
Kurshaka
Herb
Perenn
ial
Who
leplant
KohatMalakand
Gon
orrhea
Anacardiaceae
Schinu
smolleLKU
H-812
Toor
maruch
Tree
Perenn
ial
Barkleaffruits
Bann
uMenses
Amaryllid
aceae
Alliu
msativ
umLKU
H-813
Thom
aHerb
Perenn
ial
Seeds
Karak
Menses
Alliu
mcepa
LKU
H-814
Thrashto
Herb
Perenn
ial
Bulb
Chitral
Gyn
aem
enses
Brassic
aceae
Brassicacampestr
isLKU
H-815
Sarson
Herb
Ann
ual
Leaves
MalakandKo
hat
Karak
Mastitis
Sisymbrium
irioLKU
H-816
Khelik
heli
Herb
Ann
ual
Seeds
ChitralK
arakB
annu
Pregnancy
Cann
abaceae
Cann
abissativaLKU
H-817
Bang
aHerb
Ann
ual
Leaves
andbark
Bann
uMalakand
Mansehra
Gon
orrheapregn
ancy
Cela
straceae
Gymnosporiaroyleana
Wallex
MAL
awsonKU
H-818
Pataki
Shrub
Perenn
ial
Seed
MansehraKa
rak
Pregnancy
Con
volvulaceae
Convolvulusa
rvensis
LKU
H-819
Pryvatay
Herb
Perenn
ial
Who
leplant
KarakBa
nnu
MalakandKo
hat
Menses
Cucurbita
ceae
Citru
lluscolocynthis(L)Schrad
KUH-820
Maraginyetr
uhHerb
Perenn
ial
Rootsa
ndfruits
Bann
uAb
ortifacientm
astitis
Cyperaceae
Cyperusrotun
dusL
KUH-821
Delloca
Herb
Perenn
ial
Who
leplant
Bann
uMenses
Equisetaceae
Equisetum
ramosissim
umDesf
KUH-822
Jorterhorse
tail
Herb
Perenn
ial
Who
leplant
Mansehra
Gon
orrhea
Fabaceae
Acaciafarnesiana
(L)Willd
KUH-823
Vilayatikikar
Tree
Perenn
ial
Gum
Kohat
Leucorrhoea
Acaciamodesta
WallKU
H-824
Palosa
Tree
Perenn
ial
Who
leplant
KohatKa
rakBa
nnu
Mansehra
Gon
orrheagyn
ae
Acacianilotica(L)Willdex
DelileKU
H-825
Kikar
Tree
Perenn
ial
Leavesbarkpo
dBa
nnuKa
rak
Mansehra
Gyn
aegon
orrhea
leucorrheafem
ale
impo
tency
Medica
gosativaLKU
H-826
Malkind
yeHerb
Perenn
ial
Leavesstem
Bann
uMenses
LotuscorniculatusL
KUH-827
Rub
Herb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Hypericaceae
Hypericu
mperfo
ratum
LKU
H-828
Sheenchai
Herb
Perenn
ial
Fruitshoo
tMalakand
Menses
Juglandaceae
Jugla
nsregiaLKU
H-829
Ghu
zTree
Perenn
ial
Bark
KohatMansehra
Gyn
ae
Juncaceae
Juncus
thom
soniiB
uchenau
KUH-830
Gaw
agHerb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Lamiaceae
Menthavirid
is(L)LKU
H-831
Podina
Herb
Perenn
ial
Leaves
Malakand
Menses
Thym
usserpyllum
LKU
H-832
Mervezei
Herb
Perenn
ial
Who
leplant
Bann
uMensesgynae
Malvaceae
Abelm
oschus
esculen
tus(L)
MoenchKU
H-833
Bhindi
Herb
Ann
ual
Fruits
Karak
Gon
orrhea
Abutilonindicum
(L)Sw
eet
KUH-834
Koso
beta
Shrub
Ann
ual
Who
leplant
Bann
uLeucorrhoeagynae
gono
rrheaabortio
nMalva
parvifloraLKU
H-835
Tikalai
Herb
Ann
ual
Leaves
Bann
uMenses
BioMed Research International 5
Table1Con
tinued
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Meliaceae
Meliaazadira
chta
LKU
H-836
Bakana
Tree
Perenn
ial
Barkfruits
gum
Bann
uKa
rak
Gon
orrhea
Myrtaceae
Eucalyptus
globu
lusL
abill
KUH-837
Lachi
Tree
Perenn
ial
Leavesoilste
mMalakand
Menses
Nyctaginaceae
Boerhaviacoccinea
Mill
KUH-838
Insutp
unara
Herb
Perenn
ial
Who
leplant
Malakand
Menses
Oleaceae
Olea
ferrugineaRo
yleK
UH-839
Khu
naTree
Perenn
ial
Fruits
leaves
Malakand
Menses
Fraxinus
xanthoxyloides(G
Don
)AD
CKU
H-840
Toor
Herb
Perenn
ial
Barkstemleaves
Chitral
Gyn
ae
Papaveraceae
Papaversom
nifer
umLKU
H-841
Posat
Herb
Ann
ual
Flow
erfruit
Mansehra
Abortifacientpregn
ancy
Plum
baginaceae
Plum
bago
zeylanica
LKU
H-842
Chmchip
attar
Shrub
Perenn
ial
Root
Mansehra
Abortifacient
Plantaginaceae
Veronica
agrestisL
KUH-843
Kho
sobeta
Herb
Ann
ual
Who
leplant
Bann
uMensespregnancy
Poaceae
Arun
dodona
xLKU
H-844
Herb
Perenn
ial
Stem
rhizome
Bann
uMenses
Desmostachya
bipinn
ata(L)
StapfK
UH-845
Gharc
hichon
aGrass
Perenn
ial
Who
leplant
Karak
Menses
Polygonaceae
Polyg
onum
biaristatum
Aitchamp
Hem
slKU
H-846
How
arSh
rub
Perenn
ial
Who
leplant
Bann
uGon
orrhea
Ranu
nculaceae
Aconitu
mheterophyllum
Wallex
RoyleK
UH-847
Patris
bhangdewana
sarbaw
ali
Herb
Perenn
ial
Latexroot
Mansehra
Gyn
ae
Rham
naceae
Zizip
husm
auritiana
Lam
KUH-848
Bera
Tree
Perenn
ial
Leavesbarkseeds
Bann
uGyn
ae
Rosaceae
Crataegussongaric
aK
Koch
KUH-849
Gho
nii
Tree
Perenn
ial
Leavesstembark
Chitral
Gyn
ae
Rubiaceae
Rand
iatetra
spermaBe
nthamp
Hoo
kfKU
H-850
Mainp
hal
Shrub
Perenn
ial
fruit
Chitral
Abortifacient
Rutaceae
Zanthoxylum
armatum
DC
KUH-851
Timbar
Tree
Perenn
ial
Fruitleaves
Mansehra
Abortifacient
Salicaceae
Salix
acmophylla
BoissK
UH-852
Chekar
Herb
Perenn
ial
Leavestwigs
Chitral
Menses
Saxifragaceae
Bergeniastracheyi(H
ookfamp
Thom
son)
EnglK
UH-853
Bisabu
rHerb
Perenn
ial
Leavesroo
tslatex
Chitral
Pregnancy
Solanaceae
Hyoscyamus
nigerL
KUH-854
Joligao
Herb
Biennial
Leaves
Chitral
Pregnancy
Solanu
msuratte
nseB
urmf
KUH-855
Manragh
onaym
ahok
riHerb
Biennial
Who
leplant
MalakandBa
nnu
Kohat
Gon
orrheapregn
ancy
With
aniacoagulan
s(Stocks)
Dun
alKU
H-856
Panirpanird
oda
Herb
Ann
ual
Fruits
KohatKa
rakBa
nnu
Leucorrhoea
With
aniasomnifer
a(L)Dun
alKU
H-857
Kotilaljanglip
aneer
Shrub
Perenn
ial
Who
leplant
MalakandMansehra
KarakBa
nnu
Leucorrheafem
ale
impo
tencymenses
DaturametelLKU
H-858
Barbaka
Shrub
Perenn
ial
Who
leplant
KarakBa
nnu
Gon
orrhea
Tamaricaceae
Tamarixaphylla
(L)HK
arst
KUH-859
Sheengh
azz
Tree
Perenn
ial
Leavesbark
KarakBa
nnu
Gyn
ae
Verbenaceae
Verbenaoffi
cinalisLKU
H-860
Koso
beeta
Herb
Perenn
ial
Who
leplant
Bann
uMalakand
Pregnancymenses
6 BioMed Research International
Table 2 General attributes of medicinal plants
Attribute Total number Percentage ()Part use
Leaves 16 313Whole plant 17 333Fruit 10 192Bark 6 115Root 5 96Stem 4 76Seed 4 76Flower 1 19
HabitHerb 31 59Shrub 7 134Trees 14 269
ReproductionAnnual 9 173Biennial 2 38Perennial 41 788
02468
101214161820
Num
ber o
f pla
nts
Abor
tion
Impo
tenc
y
Mas
titis
Leuc
orrh
oea
Abor
tifac
ient
Gyn
ae
Preg
nanc
y
Gon
orrh
ea
Men
ses
Gynaecological problems
Figure 3 Number of plants used to treat gynaecological problems
regions used different plant parts for the recipe preparationbut whole plant and leaves (33 and 31 resp) were foundto be the most frequent parts used against gynaecologicalcomplaints (Table 2) Nine types of gynaecological ailmentswere treated in study areas Majority of the plants (19) werefound to be used against menses followed by 11 plants eachfor gonorrhea and pregnancy related problems (Figure 3) Ficresults showed that all plants in different areas scored highconsensus ranges between 06 and 100 (Table 3) Majorityof the female respondents (44) were aged between 61 and70 years Total of 40 informants were illiterate followed by38 who had just primary level of education Majority of thefemales (86) interviewed were housewives followed by 14school teachers (Table 4)
4 Discussion
Present study results showed that women of studied remoteareas of Pakistan have strong traditional knowledge in theutilization of medicinal plants for variety of gynaecologi-cal disorders Traditionally the rural women prefer plantmedicines rather than modern medicine for their personalailments due to lack of modern facilities in the regionsAmong all studied regions Bannu was ranked first havinglarge number of gynaecological plants High number ofmedicinal plants in the region might be associated withthe prevalence of large number of gynaecological problemsin the Bannu region Nine types of ailments were foundtreated using ethnomedicines in Bannu region It is a waraffected region of Pakistan where traditional medicines useis a common practice [9] Karak and Malakand regions alsocontain considerable number of gynaecological plants due tothe greater plant diversity in the regions rural nature anddependency of women for their primary health care needs[11 19]
The women of the studied regions mostly use herbs(59) for the preparation of ethnomedicines followed bytrees (269) In most remote areas medicinal herbs arethe main ingredients of local medicines and consideredthe main lifeline and frequently first choice The highestuse of herbs gives an indication of the presence of greatabundance of herb species as noticed during field visits thatareas very close to houses were well covered with herbs andcenturies old traditional knowledge of the healers Commonuse of herbaceous plants has also been reported from otherregions of Pakistan [2 20] and parts of the world [21 22]Herbs can grow in variety of places like roadsides homegardens farmland wild habitats and foundmore common incomparison to other growth forms The highest tree speciesutilization might be associated with their potential to surviveeven during long dry seasons thus their abundance andavailability throughout the year is higher in arid and semiaridareas The findings are in line with some studies [10 23]while being contradictory with studies conducted elsewherewhere shrubs were more frequently used [24 25] Variationin medicinal plants growth form might be associated withdifferent sociocultural beliefs ecological status and variationin practices of traditional healers of different regions orcountries Women mostly use perennial plants (78) for thetreatment of gynaecological problems The reason behindusing perennial plants might be due to the fact that highnumber of herbs and trees in the studied regions are perennialin their reproduction status
Women of studied regions use reported medicinal plantsfor the treatment of nine types of gynaecological ailmentsMenses was found to be the most treated ailment in thestudied regions Total of 19 plants were used to treat mensesrelated problems followed by 11 plants each for gonorrhea andpregnancy 10 for gynae 6 for abortifacient 5 for leucorrheaand 2 plants each for mastitis and impotency and singleplant is used for abortion Higher plant utilization for mensesmight be due to natural phenomenon associated with varietyof complications such as abdominal or pelvic cramping
BioMed Research International 7
Table 3 Fic values of traditional medicinal plants for treating gynaecological problems in study regions
Gynaecological problems Bannu Karak Kohat Chitral Mansehra MalakandMenses 088 091 100 087 mdash 097Gonorrhea 091 093 083 mdash 092 092Mastitis 100 100 100 mdash mdash 100Pregnancy 094 081 mdash 090 072 072Leucorrhoea 091 096 082 mdash 092 100Abortion 100 mdash mdash mdash mdash mdashGynae 082 052 075 072 063 061Female impotency 091 093 mdash mdash 100 100
Table 4 Ethnographic data of study regions
Ethnographic characters Bannu Karak Malakand Chitral Mansehra Kohat PercentageAge groups
40ndash50 6 5 7 4 5 4 1051ndash60 15 12 13 12 10 10 2461ndash70 20 22 21 23 20 26 4471ndash80 9 11 9 11 15 10 22
EducationIlliterate 22 19 23 17 19 20 40Primary 18 22 20 14 19 19 38Middle 5 6 2 9 6 6 11Secondary 3 2 3 6 4 4 7University 2 1 2 4 2 1 4
OccupationHousewives 43 39 46 47 41 43 86Teachers 7 11 4 3 9 7 14
lower back pain bloating and sore breasts food cravingsmood swings and irritability headache and fatigue [2627] Different plants have been found effective in relievingmenses complications like Justicia adhatoda Schinus molleConvolvulus arvensis Cyperus rotundus and Hypericum per-foratum Rural women use different parts of plant to prepareethnomedicines however use of specific plant part dependsupon plant habit and user requirements Traditional healersmostly prefer leaves and whole plant for the formulation ofgynaecological recipes The selection of specific plant partssuggests that these parts have strong healing potential againstgynaecological disorders but these parts need phytochemicalscreening and pharmacological investigation in order tocross-check traditional knowledge Present findings are inline with other studies showing leaves and whole plants asthe most frequently used plant parts for the preparation ofdifferent ethnomedicines [21 22 28] Whole plant harvestingis considered a destructive type of harvesting and causespopulation reduction of plant species
Most of the plants were found used in more than oneregion for the same particular ailment for example Con-volvulus arvensis was used against menses complication inBannu Kohat Karak and Malakand Melia azadirachta wasfound to be effective against gonorrhea in Bannu and KarakSolanum surattense was being used against gonorrhea andpregnancy in Malakand Bannu and Kohat Such types of
resemblance using similar plants for the same type of ailmentsin different cultures or regions provide a strong signal ofbioactivity potential of the documented plant species Infor-mant consensus results showed high consensus values rangesbetween 06 and 100 for 9 disease categories in different areasHigh Fic values in these regions indicate high prevalence ofgiven gynaecological problems in these regions Accordingto Heinrich et al [17] high Fic values are very useful inthe selection of specific plants for further search of bioactivecompounds Most of the diseases were found to be treatedwith only one or two plants in the studied regions and theirFic score was also high 100 Such plants should furtherbe analyzed for their phytochemical and pharmacologicalinvestigation
Ethnographic data showed that majority of the females(44) interviewed were aged between 61 and 70 years Theseresults clearly indicate that traditional knowledge is restrictedto aged people in these regions due to least interest ofyounger generation Total of 40 informants were illiteratein these regions followed by 38 who had only primary levelof education Only 4 respondents had university level ofeducation which reflects the unavailability of standard edu-cational institutions in these areas Literate people had lessknowledge about medicinal plants as compared to illiteratepeople of the regions due to modernization and changing lifestyles Total of 86 women were housewives while only 14
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
BioMed Research International 3
latitude and 71∘1110158403210158401015840 and 73∘5110158403410158401015840E longitude with a popu-lation of about 320000 [14] Mansehra is located at 34∘201015840N73∘121015840E of KPK a province Majority of the population inthe study regions are dominated by the Pashtunrsquos ethnicgroup All the regions are rural in nature and women ofthe regions are greatly dependent upon medicinal plants andforest resources for their primary health care need and forimproving their livelihood
22 Sampling and Data Collection Data of present study wasdocumented from January 2014 to June 2014 Prior to datacollection a brief group discussion was held with the rep-resentatives (Sherin Zaman Faiz Ullah Khan and NazirKhan) of communities locally known as ldquoMalikrdquo in order togain their consent to explain objectives of the researchstudy and to assure them protection of their traditionalknowledge The selection of informants was mainly based ontheir rich indigenous knowledge and long term experience ofutilization of plants Total of 300 female respondents wereselected in six regions with 50 informants in each area Lessnumber of informant selections in each area is due to thereason of cultural and religious restrictions of females Theselected respondents were local inhabitants of the regionsaged between 40 and 80 years Data was collected in the locallanguage of the respondents and then converted into EnglishSemistructured questionnaires were designed to collect eth-nomedicinal and ethnographic data The informants wereasked about the number of gynaecological plants known tothem their gynaecological applications and their parts usedEthnographic data about the age occupation and educationof the informants were also collected All the respondents andfocal persons of the study area provided permission to publishand protect the data on traditional medicines provided bythem
23 Specimen Collection and Identification Plants docu-mented by key respondents were collected from home gar-dens and natural vegetation during field surveyThe collectedvoucher specimens were taken to the Herbarium of KohatUniversity of Science and Technology (KUST) Kohat Pak-istan
Specimen identification and confirmation were under-taken by using Flora of Pakistan and taxonomic expertsSpecimens with their label were stored at the Herbarium ofKUST
24 Data Organization The collected data on ethnogy-naecological plants and ethnography of the respondentswas organized using Microsoft Excel 2007 and summarizedusing graphical statistical methods such as percentages Thehabit of the plants was categorized into 3 classes (herbsshrubs and trees) Reproduction of medicinal plants wasclassified into annual biennial and perennial Plant partswere classified into leaves roots stem whole plant seedsfruit and flower Gynaecological disorders were dividedinto 9 categories that is menses gonorrhea leucorrhoeaabortion pregnancy gynae abortifacient female impotencyand mastitis Ages of the respondents were categorized into
0
5
10
15
20
25
Bannu Karak Malakand Mansehra Chitral Kohat
Number of plantsNumber of gynaecological problems
Figure 2 Number of plants and gynaecological problems treated indifferent regions of Pakistan
four groups (40ndash50 51ndash60 61ndash70 and 71ndash80) Education ofthe female respondents was classified into 5 classes that isilliterate primary middle secondary and university level ofeducation Occupation of the females was divided into onlytwo classes (housewives and teachers)
25 Data Analysis
251 Informant Consensus Factor (Fic) Fic was used to forthe general uses of plants in different study areas and toindicate plants of particular interests Informantsrsquo consensusis the most preferred method to highlight widely used plantsfor a particular ailment and thus aids in the selection of plantsfor pharmacological and phytochemical studies [15] Prior tousing this method illnesses were classified into categoriesas high Fic plants are likely to be more pharmacologicallyactive in comparison with low Fic value plants [16] Fic valueslie between ldquo000 and 100rdquo Fic values are always greaterwhen single plant or few plants are used by large number ofinformants to cure a specific disorder while low Fic valuesgive an indication that informants do not agree over whichplant to use [17 18] The Fic can be calculated using theformula as follows
Fic = nur minus ntnur minus 1
(1)
where Fic = informants consensus factor nur = number of usecitation in each category and nt = number of species used
3 Results
The present study revealed that women of studied regionsused about 51 plants belonging to 36 families (Table 1) Bannuregion was found with high number of gynaecological plants(22) followed by Karak (15) Malakand (14) Mansehra (11)Chitral (10) and Kohat (8) Nine types of diseases weretreated in Bannu followed by eight in Karak (Figure 2)Women of the regions mostly used herbs (59) for thepreparation of ethnomedicines followed by trees (266)(Table 2) It was found that majority of the plants (78)were perennial in their mode of reproduction Women of the
4 BioMed Research International
Table1Ethn
omedicinalplantsused
totre
atgynecologicalproblem
s
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Acanthaceae
Justicia
adhatoda
LKU
H-810
Baikar
Shrub
Perenn
ial
Rootleaves
MalakandKa
rak
Bann
uGyn
aeabo
rtifa
cient
Amaranthaceae
Achyranthesa
speraLKU
H-811
Kurshaka
Herb
Perenn
ial
Who
leplant
KohatMalakand
Gon
orrhea
Anacardiaceae
Schinu
smolleLKU
H-812
Toor
maruch
Tree
Perenn
ial
Barkleaffruits
Bann
uMenses
Amaryllid
aceae
Alliu
msativ
umLKU
H-813
Thom
aHerb
Perenn
ial
Seeds
Karak
Menses
Alliu
mcepa
LKU
H-814
Thrashto
Herb
Perenn
ial
Bulb
Chitral
Gyn
aem
enses
Brassic
aceae
Brassicacampestr
isLKU
H-815
Sarson
Herb
Ann
ual
Leaves
MalakandKo
hat
Karak
Mastitis
Sisymbrium
irioLKU
H-816
Khelik
heli
Herb
Ann
ual
Seeds
ChitralK
arakB
annu
Pregnancy
Cann
abaceae
Cann
abissativaLKU
H-817
Bang
aHerb
Ann
ual
Leaves
andbark
Bann
uMalakand
Mansehra
Gon
orrheapregn
ancy
Cela
straceae
Gymnosporiaroyleana
Wallex
MAL
awsonKU
H-818
Pataki
Shrub
Perenn
ial
Seed
MansehraKa
rak
Pregnancy
Con
volvulaceae
Convolvulusa
rvensis
LKU
H-819
Pryvatay
Herb
Perenn
ial
Who
leplant
KarakBa
nnu
MalakandKo
hat
Menses
Cucurbita
ceae
Citru
lluscolocynthis(L)Schrad
KUH-820
Maraginyetr
uhHerb
Perenn
ial
Rootsa
ndfruits
Bann
uAb
ortifacientm
astitis
Cyperaceae
Cyperusrotun
dusL
KUH-821
Delloca
Herb
Perenn
ial
Who
leplant
Bann
uMenses
Equisetaceae
Equisetum
ramosissim
umDesf
KUH-822
Jorterhorse
tail
Herb
Perenn
ial
Who
leplant
Mansehra
Gon
orrhea
Fabaceae
Acaciafarnesiana
(L)Willd
KUH-823
Vilayatikikar
Tree
Perenn
ial
Gum
Kohat
Leucorrhoea
Acaciamodesta
WallKU
H-824
Palosa
Tree
Perenn
ial
Who
leplant
KohatKa
rakBa
nnu
Mansehra
Gon
orrheagyn
ae
Acacianilotica(L)Willdex
DelileKU
H-825
Kikar
Tree
Perenn
ial
Leavesbarkpo
dBa
nnuKa
rak
Mansehra
Gyn
aegon
orrhea
leucorrheafem
ale
impo
tency
Medica
gosativaLKU
H-826
Malkind
yeHerb
Perenn
ial
Leavesstem
Bann
uMenses
LotuscorniculatusL
KUH-827
Rub
Herb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Hypericaceae
Hypericu
mperfo
ratum
LKU
H-828
Sheenchai
Herb
Perenn
ial
Fruitshoo
tMalakand
Menses
Juglandaceae
Jugla
nsregiaLKU
H-829
Ghu
zTree
Perenn
ial
Bark
KohatMansehra
Gyn
ae
Juncaceae
Juncus
thom
soniiB
uchenau
KUH-830
Gaw
agHerb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Lamiaceae
Menthavirid
is(L)LKU
H-831
Podina
Herb
Perenn
ial
Leaves
Malakand
Menses
Thym
usserpyllum
LKU
H-832
Mervezei
Herb
Perenn
ial
Who
leplant
Bann
uMensesgynae
Malvaceae
Abelm
oschus
esculen
tus(L)
MoenchKU
H-833
Bhindi
Herb
Ann
ual
Fruits
Karak
Gon
orrhea
Abutilonindicum
(L)Sw
eet
KUH-834
Koso
beta
Shrub
Ann
ual
Who
leplant
Bann
uLeucorrhoeagynae
gono
rrheaabortio
nMalva
parvifloraLKU
H-835
Tikalai
Herb
Ann
ual
Leaves
Bann
uMenses
BioMed Research International 5
Table1Con
tinued
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Meliaceae
Meliaazadira
chta
LKU
H-836
Bakana
Tree
Perenn
ial
Barkfruits
gum
Bann
uKa
rak
Gon
orrhea
Myrtaceae
Eucalyptus
globu
lusL
abill
KUH-837
Lachi
Tree
Perenn
ial
Leavesoilste
mMalakand
Menses
Nyctaginaceae
Boerhaviacoccinea
Mill
KUH-838
Insutp
unara
Herb
Perenn
ial
Who
leplant
Malakand
Menses
Oleaceae
Olea
ferrugineaRo
yleK
UH-839
Khu
naTree
Perenn
ial
Fruits
leaves
Malakand
Menses
Fraxinus
xanthoxyloides(G
Don
)AD
CKU
H-840
Toor
Herb
Perenn
ial
Barkstemleaves
Chitral
Gyn
ae
Papaveraceae
Papaversom
nifer
umLKU
H-841
Posat
Herb
Ann
ual
Flow
erfruit
Mansehra
Abortifacientpregn
ancy
Plum
baginaceae
Plum
bago
zeylanica
LKU
H-842
Chmchip
attar
Shrub
Perenn
ial
Root
Mansehra
Abortifacient
Plantaginaceae
Veronica
agrestisL
KUH-843
Kho
sobeta
Herb
Ann
ual
Who
leplant
Bann
uMensespregnancy
Poaceae
Arun
dodona
xLKU
H-844
Herb
Perenn
ial
Stem
rhizome
Bann
uMenses
Desmostachya
bipinn
ata(L)
StapfK
UH-845
Gharc
hichon
aGrass
Perenn
ial
Who
leplant
Karak
Menses
Polygonaceae
Polyg
onum
biaristatum
Aitchamp
Hem
slKU
H-846
How
arSh
rub
Perenn
ial
Who
leplant
Bann
uGon
orrhea
Ranu
nculaceae
Aconitu
mheterophyllum
Wallex
RoyleK
UH-847
Patris
bhangdewana
sarbaw
ali
Herb
Perenn
ial
Latexroot
Mansehra
Gyn
ae
Rham
naceae
Zizip
husm
auritiana
Lam
KUH-848
Bera
Tree
Perenn
ial
Leavesbarkseeds
Bann
uGyn
ae
Rosaceae
Crataegussongaric
aK
Koch
KUH-849
Gho
nii
Tree
Perenn
ial
Leavesstembark
Chitral
Gyn
ae
Rubiaceae
Rand
iatetra
spermaBe
nthamp
Hoo
kfKU
H-850
Mainp
hal
Shrub
Perenn
ial
fruit
Chitral
Abortifacient
Rutaceae
Zanthoxylum
armatum
DC
KUH-851
Timbar
Tree
Perenn
ial
Fruitleaves
Mansehra
Abortifacient
Salicaceae
Salix
acmophylla
BoissK
UH-852
Chekar
Herb
Perenn
ial
Leavestwigs
Chitral
Menses
Saxifragaceae
Bergeniastracheyi(H
ookfamp
Thom
son)
EnglK
UH-853
Bisabu
rHerb
Perenn
ial
Leavesroo
tslatex
Chitral
Pregnancy
Solanaceae
Hyoscyamus
nigerL
KUH-854
Joligao
Herb
Biennial
Leaves
Chitral
Pregnancy
Solanu
msuratte
nseB
urmf
KUH-855
Manragh
onaym
ahok
riHerb
Biennial
Who
leplant
MalakandBa
nnu
Kohat
Gon
orrheapregn
ancy
With
aniacoagulan
s(Stocks)
Dun
alKU
H-856
Panirpanird
oda
Herb
Ann
ual
Fruits
KohatKa
rakBa
nnu
Leucorrhoea
With
aniasomnifer
a(L)Dun
alKU
H-857
Kotilaljanglip
aneer
Shrub
Perenn
ial
Who
leplant
MalakandMansehra
KarakBa
nnu
Leucorrheafem
ale
impo
tencymenses
DaturametelLKU
H-858
Barbaka
Shrub
Perenn
ial
Who
leplant
KarakBa
nnu
Gon
orrhea
Tamaricaceae
Tamarixaphylla
(L)HK
arst
KUH-859
Sheengh
azz
Tree
Perenn
ial
Leavesbark
KarakBa
nnu
Gyn
ae
Verbenaceae
Verbenaoffi
cinalisLKU
H-860
Koso
beeta
Herb
Perenn
ial
Who
leplant
Bann
uMalakand
Pregnancymenses
6 BioMed Research International
Table 2 General attributes of medicinal plants
Attribute Total number Percentage ()Part use
Leaves 16 313Whole plant 17 333Fruit 10 192Bark 6 115Root 5 96Stem 4 76Seed 4 76Flower 1 19
HabitHerb 31 59Shrub 7 134Trees 14 269
ReproductionAnnual 9 173Biennial 2 38Perennial 41 788
02468
101214161820
Num
ber o
f pla
nts
Abor
tion
Impo
tenc
y
Mas
titis
Leuc
orrh
oea
Abor
tifac
ient
Gyn
ae
Preg
nanc
y
Gon
orrh
ea
Men
ses
Gynaecological problems
Figure 3 Number of plants used to treat gynaecological problems
regions used different plant parts for the recipe preparationbut whole plant and leaves (33 and 31 resp) were foundto be the most frequent parts used against gynaecologicalcomplaints (Table 2) Nine types of gynaecological ailmentswere treated in study areas Majority of the plants (19) werefound to be used against menses followed by 11 plants eachfor gonorrhea and pregnancy related problems (Figure 3) Ficresults showed that all plants in different areas scored highconsensus ranges between 06 and 100 (Table 3) Majorityof the female respondents (44) were aged between 61 and70 years Total of 40 informants were illiterate followed by38 who had just primary level of education Majority of thefemales (86) interviewed were housewives followed by 14school teachers (Table 4)
4 Discussion
Present study results showed that women of studied remoteareas of Pakistan have strong traditional knowledge in theutilization of medicinal plants for variety of gynaecologi-cal disorders Traditionally the rural women prefer plantmedicines rather than modern medicine for their personalailments due to lack of modern facilities in the regionsAmong all studied regions Bannu was ranked first havinglarge number of gynaecological plants High number ofmedicinal plants in the region might be associated withthe prevalence of large number of gynaecological problemsin the Bannu region Nine types of ailments were foundtreated using ethnomedicines in Bannu region It is a waraffected region of Pakistan where traditional medicines useis a common practice [9] Karak and Malakand regions alsocontain considerable number of gynaecological plants due tothe greater plant diversity in the regions rural nature anddependency of women for their primary health care needs[11 19]
The women of the studied regions mostly use herbs(59) for the preparation of ethnomedicines followed bytrees (269) In most remote areas medicinal herbs arethe main ingredients of local medicines and consideredthe main lifeline and frequently first choice The highestuse of herbs gives an indication of the presence of greatabundance of herb species as noticed during field visits thatareas very close to houses were well covered with herbs andcenturies old traditional knowledge of the healers Commonuse of herbaceous plants has also been reported from otherregions of Pakistan [2 20] and parts of the world [21 22]Herbs can grow in variety of places like roadsides homegardens farmland wild habitats and foundmore common incomparison to other growth forms The highest tree speciesutilization might be associated with their potential to surviveeven during long dry seasons thus their abundance andavailability throughout the year is higher in arid and semiaridareas The findings are in line with some studies [10 23]while being contradictory with studies conducted elsewherewhere shrubs were more frequently used [24 25] Variationin medicinal plants growth form might be associated withdifferent sociocultural beliefs ecological status and variationin practices of traditional healers of different regions orcountries Women mostly use perennial plants (78) for thetreatment of gynaecological problems The reason behindusing perennial plants might be due to the fact that highnumber of herbs and trees in the studied regions are perennialin their reproduction status
Women of studied regions use reported medicinal plantsfor the treatment of nine types of gynaecological ailmentsMenses was found to be the most treated ailment in thestudied regions Total of 19 plants were used to treat mensesrelated problems followed by 11 plants each for gonorrhea andpregnancy 10 for gynae 6 for abortifacient 5 for leucorrheaand 2 plants each for mastitis and impotency and singleplant is used for abortion Higher plant utilization for mensesmight be due to natural phenomenon associated with varietyof complications such as abdominal or pelvic cramping
BioMed Research International 7
Table 3 Fic values of traditional medicinal plants for treating gynaecological problems in study regions
Gynaecological problems Bannu Karak Kohat Chitral Mansehra MalakandMenses 088 091 100 087 mdash 097Gonorrhea 091 093 083 mdash 092 092Mastitis 100 100 100 mdash mdash 100Pregnancy 094 081 mdash 090 072 072Leucorrhoea 091 096 082 mdash 092 100Abortion 100 mdash mdash mdash mdash mdashGynae 082 052 075 072 063 061Female impotency 091 093 mdash mdash 100 100
Table 4 Ethnographic data of study regions
Ethnographic characters Bannu Karak Malakand Chitral Mansehra Kohat PercentageAge groups
40ndash50 6 5 7 4 5 4 1051ndash60 15 12 13 12 10 10 2461ndash70 20 22 21 23 20 26 4471ndash80 9 11 9 11 15 10 22
EducationIlliterate 22 19 23 17 19 20 40Primary 18 22 20 14 19 19 38Middle 5 6 2 9 6 6 11Secondary 3 2 3 6 4 4 7University 2 1 2 4 2 1 4
OccupationHousewives 43 39 46 47 41 43 86Teachers 7 11 4 3 9 7 14
lower back pain bloating and sore breasts food cravingsmood swings and irritability headache and fatigue [2627] Different plants have been found effective in relievingmenses complications like Justicia adhatoda Schinus molleConvolvulus arvensis Cyperus rotundus and Hypericum per-foratum Rural women use different parts of plant to prepareethnomedicines however use of specific plant part dependsupon plant habit and user requirements Traditional healersmostly prefer leaves and whole plant for the formulation ofgynaecological recipes The selection of specific plant partssuggests that these parts have strong healing potential againstgynaecological disorders but these parts need phytochemicalscreening and pharmacological investigation in order tocross-check traditional knowledge Present findings are inline with other studies showing leaves and whole plants asthe most frequently used plant parts for the preparation ofdifferent ethnomedicines [21 22 28] Whole plant harvestingis considered a destructive type of harvesting and causespopulation reduction of plant species
Most of the plants were found used in more than oneregion for the same particular ailment for example Con-volvulus arvensis was used against menses complication inBannu Kohat Karak and Malakand Melia azadirachta wasfound to be effective against gonorrhea in Bannu and KarakSolanum surattense was being used against gonorrhea andpregnancy in Malakand Bannu and Kohat Such types of
resemblance using similar plants for the same type of ailmentsin different cultures or regions provide a strong signal ofbioactivity potential of the documented plant species Infor-mant consensus results showed high consensus values rangesbetween 06 and 100 for 9 disease categories in different areasHigh Fic values in these regions indicate high prevalence ofgiven gynaecological problems in these regions Accordingto Heinrich et al [17] high Fic values are very useful inthe selection of specific plants for further search of bioactivecompounds Most of the diseases were found to be treatedwith only one or two plants in the studied regions and theirFic score was also high 100 Such plants should furtherbe analyzed for their phytochemical and pharmacologicalinvestigation
Ethnographic data showed that majority of the females(44) interviewed were aged between 61 and 70 years Theseresults clearly indicate that traditional knowledge is restrictedto aged people in these regions due to least interest ofyounger generation Total of 40 informants were illiteratein these regions followed by 38 who had only primary levelof education Only 4 respondents had university level ofeducation which reflects the unavailability of standard edu-cational institutions in these areas Literate people had lessknowledge about medicinal plants as compared to illiteratepeople of the regions due to modernization and changing lifestyles Total of 86 women were housewives while only 14
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
4 BioMed Research International
Table1Ethn
omedicinalplantsused
totre
atgynecologicalproblem
s
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Acanthaceae
Justicia
adhatoda
LKU
H-810
Baikar
Shrub
Perenn
ial
Rootleaves
MalakandKa
rak
Bann
uGyn
aeabo
rtifa
cient
Amaranthaceae
Achyranthesa
speraLKU
H-811
Kurshaka
Herb
Perenn
ial
Who
leplant
KohatMalakand
Gon
orrhea
Anacardiaceae
Schinu
smolleLKU
H-812
Toor
maruch
Tree
Perenn
ial
Barkleaffruits
Bann
uMenses
Amaryllid
aceae
Alliu
msativ
umLKU
H-813
Thom
aHerb
Perenn
ial
Seeds
Karak
Menses
Alliu
mcepa
LKU
H-814
Thrashto
Herb
Perenn
ial
Bulb
Chitral
Gyn
aem
enses
Brassic
aceae
Brassicacampestr
isLKU
H-815
Sarson
Herb
Ann
ual
Leaves
MalakandKo
hat
Karak
Mastitis
Sisymbrium
irioLKU
H-816
Khelik
heli
Herb
Ann
ual
Seeds
ChitralK
arakB
annu
Pregnancy
Cann
abaceae
Cann
abissativaLKU
H-817
Bang
aHerb
Ann
ual
Leaves
andbark
Bann
uMalakand
Mansehra
Gon
orrheapregn
ancy
Cela
straceae
Gymnosporiaroyleana
Wallex
MAL
awsonKU
H-818
Pataki
Shrub
Perenn
ial
Seed
MansehraKa
rak
Pregnancy
Con
volvulaceae
Convolvulusa
rvensis
LKU
H-819
Pryvatay
Herb
Perenn
ial
Who
leplant
KarakBa
nnu
MalakandKo
hat
Menses
Cucurbita
ceae
Citru
lluscolocynthis(L)Schrad
KUH-820
Maraginyetr
uhHerb
Perenn
ial
Rootsa
ndfruits
Bann
uAb
ortifacientm
astitis
Cyperaceae
Cyperusrotun
dusL
KUH-821
Delloca
Herb
Perenn
ial
Who
leplant
Bann
uMenses
Equisetaceae
Equisetum
ramosissim
umDesf
KUH-822
Jorterhorse
tail
Herb
Perenn
ial
Who
leplant
Mansehra
Gon
orrhea
Fabaceae
Acaciafarnesiana
(L)Willd
KUH-823
Vilayatikikar
Tree
Perenn
ial
Gum
Kohat
Leucorrhoea
Acaciamodesta
WallKU
H-824
Palosa
Tree
Perenn
ial
Who
leplant
KohatKa
rakBa
nnu
Mansehra
Gon
orrheagyn
ae
Acacianilotica(L)Willdex
DelileKU
H-825
Kikar
Tree
Perenn
ial
Leavesbarkpo
dBa
nnuKa
rak
Mansehra
Gyn
aegon
orrhea
leucorrheafem
ale
impo
tency
Medica
gosativaLKU
H-826
Malkind
yeHerb
Perenn
ial
Leavesstem
Bann
uMenses
LotuscorniculatusL
KUH-827
Rub
Herb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Hypericaceae
Hypericu
mperfo
ratum
LKU
H-828
Sheenchai
Herb
Perenn
ial
Fruitshoo
tMalakand
Menses
Juglandaceae
Jugla
nsregiaLKU
H-829
Ghu
zTree
Perenn
ial
Bark
KohatMansehra
Gyn
ae
Juncaceae
Juncus
thom
soniiB
uchenau
KUH-830
Gaw
agHerb
Perenn
ial
Who
leplant
Chitral
Pregnancy
Lamiaceae
Menthavirid
is(L)LKU
H-831
Podina
Herb
Perenn
ial
Leaves
Malakand
Menses
Thym
usserpyllum
LKU
H-832
Mervezei
Herb
Perenn
ial
Who
leplant
Bann
uMensesgynae
Malvaceae
Abelm
oschus
esculen
tus(L)
MoenchKU
H-833
Bhindi
Herb
Ann
ual
Fruits
Karak
Gon
orrhea
Abutilonindicum
(L)Sw
eet
KUH-834
Koso
beta
Shrub
Ann
ual
Who
leplant
Bann
uLeucorrhoeagynae
gono
rrheaabortio
nMalva
parvifloraLKU
H-835
Tikalai
Herb
Ann
ual
Leaves
Bann
uMenses
BioMed Research International 5
Table1Con
tinued
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Meliaceae
Meliaazadira
chta
LKU
H-836
Bakana
Tree
Perenn
ial
Barkfruits
gum
Bann
uKa
rak
Gon
orrhea
Myrtaceae
Eucalyptus
globu
lusL
abill
KUH-837
Lachi
Tree
Perenn
ial
Leavesoilste
mMalakand
Menses
Nyctaginaceae
Boerhaviacoccinea
Mill
KUH-838
Insutp
unara
Herb
Perenn
ial
Who
leplant
Malakand
Menses
Oleaceae
Olea
ferrugineaRo
yleK
UH-839
Khu
naTree
Perenn
ial
Fruits
leaves
Malakand
Menses
Fraxinus
xanthoxyloides(G
Don
)AD
CKU
H-840
Toor
Herb
Perenn
ial
Barkstemleaves
Chitral
Gyn
ae
Papaveraceae
Papaversom
nifer
umLKU
H-841
Posat
Herb
Ann
ual
Flow
erfruit
Mansehra
Abortifacientpregn
ancy
Plum
baginaceae
Plum
bago
zeylanica
LKU
H-842
Chmchip
attar
Shrub
Perenn
ial
Root
Mansehra
Abortifacient
Plantaginaceae
Veronica
agrestisL
KUH-843
Kho
sobeta
Herb
Ann
ual
Who
leplant
Bann
uMensespregnancy
Poaceae
Arun
dodona
xLKU
H-844
Herb
Perenn
ial
Stem
rhizome
Bann
uMenses
Desmostachya
bipinn
ata(L)
StapfK
UH-845
Gharc
hichon
aGrass
Perenn
ial
Who
leplant
Karak
Menses
Polygonaceae
Polyg
onum
biaristatum
Aitchamp
Hem
slKU
H-846
How
arSh
rub
Perenn
ial
Who
leplant
Bann
uGon
orrhea
Ranu
nculaceae
Aconitu
mheterophyllum
Wallex
RoyleK
UH-847
Patris
bhangdewana
sarbaw
ali
Herb
Perenn
ial
Latexroot
Mansehra
Gyn
ae
Rham
naceae
Zizip
husm
auritiana
Lam
KUH-848
Bera
Tree
Perenn
ial
Leavesbarkseeds
Bann
uGyn
ae
Rosaceae
Crataegussongaric
aK
Koch
KUH-849
Gho
nii
Tree
Perenn
ial
Leavesstembark
Chitral
Gyn
ae
Rubiaceae
Rand
iatetra
spermaBe
nthamp
Hoo
kfKU
H-850
Mainp
hal
Shrub
Perenn
ial
fruit
Chitral
Abortifacient
Rutaceae
Zanthoxylum
armatum
DC
KUH-851
Timbar
Tree
Perenn
ial
Fruitleaves
Mansehra
Abortifacient
Salicaceae
Salix
acmophylla
BoissK
UH-852
Chekar
Herb
Perenn
ial
Leavestwigs
Chitral
Menses
Saxifragaceae
Bergeniastracheyi(H
ookfamp
Thom
son)
EnglK
UH-853
Bisabu
rHerb
Perenn
ial
Leavesroo
tslatex
Chitral
Pregnancy
Solanaceae
Hyoscyamus
nigerL
KUH-854
Joligao
Herb
Biennial
Leaves
Chitral
Pregnancy
Solanu
msuratte
nseB
urmf
KUH-855
Manragh
onaym
ahok
riHerb
Biennial
Who
leplant
MalakandBa
nnu
Kohat
Gon
orrheapregn
ancy
With
aniacoagulan
s(Stocks)
Dun
alKU
H-856
Panirpanird
oda
Herb
Ann
ual
Fruits
KohatKa
rakBa
nnu
Leucorrhoea
With
aniasomnifer
a(L)Dun
alKU
H-857
Kotilaljanglip
aneer
Shrub
Perenn
ial
Who
leplant
MalakandMansehra
KarakBa
nnu
Leucorrheafem
ale
impo
tencymenses
DaturametelLKU
H-858
Barbaka
Shrub
Perenn
ial
Who
leplant
KarakBa
nnu
Gon
orrhea
Tamaricaceae
Tamarixaphylla
(L)HK
arst
KUH-859
Sheengh
azz
Tree
Perenn
ial
Leavesbark
KarakBa
nnu
Gyn
ae
Verbenaceae
Verbenaoffi
cinalisLKU
H-860
Koso
beeta
Herb
Perenn
ial
Who
leplant
Bann
uMalakand
Pregnancymenses
6 BioMed Research International
Table 2 General attributes of medicinal plants
Attribute Total number Percentage ()Part use
Leaves 16 313Whole plant 17 333Fruit 10 192Bark 6 115Root 5 96Stem 4 76Seed 4 76Flower 1 19
HabitHerb 31 59Shrub 7 134Trees 14 269
ReproductionAnnual 9 173Biennial 2 38Perennial 41 788
02468
101214161820
Num
ber o
f pla
nts
Abor
tion
Impo
tenc
y
Mas
titis
Leuc
orrh
oea
Abor
tifac
ient
Gyn
ae
Preg
nanc
y
Gon
orrh
ea
Men
ses
Gynaecological problems
Figure 3 Number of plants used to treat gynaecological problems
regions used different plant parts for the recipe preparationbut whole plant and leaves (33 and 31 resp) were foundto be the most frequent parts used against gynaecologicalcomplaints (Table 2) Nine types of gynaecological ailmentswere treated in study areas Majority of the plants (19) werefound to be used against menses followed by 11 plants eachfor gonorrhea and pregnancy related problems (Figure 3) Ficresults showed that all plants in different areas scored highconsensus ranges between 06 and 100 (Table 3) Majorityof the female respondents (44) were aged between 61 and70 years Total of 40 informants were illiterate followed by38 who had just primary level of education Majority of thefemales (86) interviewed were housewives followed by 14school teachers (Table 4)
4 Discussion
Present study results showed that women of studied remoteareas of Pakistan have strong traditional knowledge in theutilization of medicinal plants for variety of gynaecologi-cal disorders Traditionally the rural women prefer plantmedicines rather than modern medicine for their personalailments due to lack of modern facilities in the regionsAmong all studied regions Bannu was ranked first havinglarge number of gynaecological plants High number ofmedicinal plants in the region might be associated withthe prevalence of large number of gynaecological problemsin the Bannu region Nine types of ailments were foundtreated using ethnomedicines in Bannu region It is a waraffected region of Pakistan where traditional medicines useis a common practice [9] Karak and Malakand regions alsocontain considerable number of gynaecological plants due tothe greater plant diversity in the regions rural nature anddependency of women for their primary health care needs[11 19]
The women of the studied regions mostly use herbs(59) for the preparation of ethnomedicines followed bytrees (269) In most remote areas medicinal herbs arethe main ingredients of local medicines and consideredthe main lifeline and frequently first choice The highestuse of herbs gives an indication of the presence of greatabundance of herb species as noticed during field visits thatareas very close to houses were well covered with herbs andcenturies old traditional knowledge of the healers Commonuse of herbaceous plants has also been reported from otherregions of Pakistan [2 20] and parts of the world [21 22]Herbs can grow in variety of places like roadsides homegardens farmland wild habitats and foundmore common incomparison to other growth forms The highest tree speciesutilization might be associated with their potential to surviveeven during long dry seasons thus their abundance andavailability throughout the year is higher in arid and semiaridareas The findings are in line with some studies [10 23]while being contradictory with studies conducted elsewherewhere shrubs were more frequently used [24 25] Variationin medicinal plants growth form might be associated withdifferent sociocultural beliefs ecological status and variationin practices of traditional healers of different regions orcountries Women mostly use perennial plants (78) for thetreatment of gynaecological problems The reason behindusing perennial plants might be due to the fact that highnumber of herbs and trees in the studied regions are perennialin their reproduction status
Women of studied regions use reported medicinal plantsfor the treatment of nine types of gynaecological ailmentsMenses was found to be the most treated ailment in thestudied regions Total of 19 plants were used to treat mensesrelated problems followed by 11 plants each for gonorrhea andpregnancy 10 for gynae 6 for abortifacient 5 for leucorrheaand 2 plants each for mastitis and impotency and singleplant is used for abortion Higher plant utilization for mensesmight be due to natural phenomenon associated with varietyof complications such as abdominal or pelvic cramping
BioMed Research International 7
Table 3 Fic values of traditional medicinal plants for treating gynaecological problems in study regions
Gynaecological problems Bannu Karak Kohat Chitral Mansehra MalakandMenses 088 091 100 087 mdash 097Gonorrhea 091 093 083 mdash 092 092Mastitis 100 100 100 mdash mdash 100Pregnancy 094 081 mdash 090 072 072Leucorrhoea 091 096 082 mdash 092 100Abortion 100 mdash mdash mdash mdash mdashGynae 082 052 075 072 063 061Female impotency 091 093 mdash mdash 100 100
Table 4 Ethnographic data of study regions
Ethnographic characters Bannu Karak Malakand Chitral Mansehra Kohat PercentageAge groups
40ndash50 6 5 7 4 5 4 1051ndash60 15 12 13 12 10 10 2461ndash70 20 22 21 23 20 26 4471ndash80 9 11 9 11 15 10 22
EducationIlliterate 22 19 23 17 19 20 40Primary 18 22 20 14 19 19 38Middle 5 6 2 9 6 6 11Secondary 3 2 3 6 4 4 7University 2 1 2 4 2 1 4
OccupationHousewives 43 39 46 47 41 43 86Teachers 7 11 4 3 9 7 14
lower back pain bloating and sore breasts food cravingsmood swings and irritability headache and fatigue [2627] Different plants have been found effective in relievingmenses complications like Justicia adhatoda Schinus molleConvolvulus arvensis Cyperus rotundus and Hypericum per-foratum Rural women use different parts of plant to prepareethnomedicines however use of specific plant part dependsupon plant habit and user requirements Traditional healersmostly prefer leaves and whole plant for the formulation ofgynaecological recipes The selection of specific plant partssuggests that these parts have strong healing potential againstgynaecological disorders but these parts need phytochemicalscreening and pharmacological investigation in order tocross-check traditional knowledge Present findings are inline with other studies showing leaves and whole plants asthe most frequently used plant parts for the preparation ofdifferent ethnomedicines [21 22 28] Whole plant harvestingis considered a destructive type of harvesting and causespopulation reduction of plant species
Most of the plants were found used in more than oneregion for the same particular ailment for example Con-volvulus arvensis was used against menses complication inBannu Kohat Karak and Malakand Melia azadirachta wasfound to be effective against gonorrhea in Bannu and KarakSolanum surattense was being used against gonorrhea andpregnancy in Malakand Bannu and Kohat Such types of
resemblance using similar plants for the same type of ailmentsin different cultures or regions provide a strong signal ofbioactivity potential of the documented plant species Infor-mant consensus results showed high consensus values rangesbetween 06 and 100 for 9 disease categories in different areasHigh Fic values in these regions indicate high prevalence ofgiven gynaecological problems in these regions Accordingto Heinrich et al [17] high Fic values are very useful inthe selection of specific plants for further search of bioactivecompounds Most of the diseases were found to be treatedwith only one or two plants in the studied regions and theirFic score was also high 100 Such plants should furtherbe analyzed for their phytochemical and pharmacologicalinvestigation
Ethnographic data showed that majority of the females(44) interviewed were aged between 61 and 70 years Theseresults clearly indicate that traditional knowledge is restrictedto aged people in these regions due to least interest ofyounger generation Total of 40 informants were illiteratein these regions followed by 38 who had only primary levelof education Only 4 respondents had university level ofeducation which reflects the unavailability of standard edu-cational institutions in these areas Literate people had lessknowledge about medicinal plants as compared to illiteratepeople of the regions due to modernization and changing lifestyles Total of 86 women were housewives while only 14
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
BioMed Research International 5
Table1Con
tinued
Plantfam
ilies
Scientificn
amesvou
cher
no
Localn
ames
Habit
Reprod
uctio
nPartused
Region
Gyn
aecological
prob
lems
Meliaceae
Meliaazadira
chta
LKU
H-836
Bakana
Tree
Perenn
ial
Barkfruits
gum
Bann
uKa
rak
Gon
orrhea
Myrtaceae
Eucalyptus
globu
lusL
abill
KUH-837
Lachi
Tree
Perenn
ial
Leavesoilste
mMalakand
Menses
Nyctaginaceae
Boerhaviacoccinea
Mill
KUH-838
Insutp
unara
Herb
Perenn
ial
Who
leplant
Malakand
Menses
Oleaceae
Olea
ferrugineaRo
yleK
UH-839
Khu
naTree
Perenn
ial
Fruits
leaves
Malakand
Menses
Fraxinus
xanthoxyloides(G
Don
)AD
CKU
H-840
Toor
Herb
Perenn
ial
Barkstemleaves
Chitral
Gyn
ae
Papaveraceae
Papaversom
nifer
umLKU
H-841
Posat
Herb
Ann
ual
Flow
erfruit
Mansehra
Abortifacientpregn
ancy
Plum
baginaceae
Plum
bago
zeylanica
LKU
H-842
Chmchip
attar
Shrub
Perenn
ial
Root
Mansehra
Abortifacient
Plantaginaceae
Veronica
agrestisL
KUH-843
Kho
sobeta
Herb
Ann
ual
Who
leplant
Bann
uMensespregnancy
Poaceae
Arun
dodona
xLKU
H-844
Herb
Perenn
ial
Stem
rhizome
Bann
uMenses
Desmostachya
bipinn
ata(L)
StapfK
UH-845
Gharc
hichon
aGrass
Perenn
ial
Who
leplant
Karak
Menses
Polygonaceae
Polyg
onum
biaristatum
Aitchamp
Hem
slKU
H-846
How
arSh
rub
Perenn
ial
Who
leplant
Bann
uGon
orrhea
Ranu
nculaceae
Aconitu
mheterophyllum
Wallex
RoyleK
UH-847
Patris
bhangdewana
sarbaw
ali
Herb
Perenn
ial
Latexroot
Mansehra
Gyn
ae
Rham
naceae
Zizip
husm
auritiana
Lam
KUH-848
Bera
Tree
Perenn
ial
Leavesbarkseeds
Bann
uGyn
ae
Rosaceae
Crataegussongaric
aK
Koch
KUH-849
Gho
nii
Tree
Perenn
ial
Leavesstembark
Chitral
Gyn
ae
Rubiaceae
Rand
iatetra
spermaBe
nthamp
Hoo
kfKU
H-850
Mainp
hal
Shrub
Perenn
ial
fruit
Chitral
Abortifacient
Rutaceae
Zanthoxylum
armatum
DC
KUH-851
Timbar
Tree
Perenn
ial
Fruitleaves
Mansehra
Abortifacient
Salicaceae
Salix
acmophylla
BoissK
UH-852
Chekar
Herb
Perenn
ial
Leavestwigs
Chitral
Menses
Saxifragaceae
Bergeniastracheyi(H
ookfamp
Thom
son)
EnglK
UH-853
Bisabu
rHerb
Perenn
ial
Leavesroo
tslatex
Chitral
Pregnancy
Solanaceae
Hyoscyamus
nigerL
KUH-854
Joligao
Herb
Biennial
Leaves
Chitral
Pregnancy
Solanu
msuratte
nseB
urmf
KUH-855
Manragh
onaym
ahok
riHerb
Biennial
Who
leplant
MalakandBa
nnu
Kohat
Gon
orrheapregn
ancy
With
aniacoagulan
s(Stocks)
Dun
alKU
H-856
Panirpanird
oda
Herb
Ann
ual
Fruits
KohatKa
rakBa
nnu
Leucorrhoea
With
aniasomnifer
a(L)Dun
alKU
H-857
Kotilaljanglip
aneer
Shrub
Perenn
ial
Who
leplant
MalakandMansehra
KarakBa
nnu
Leucorrheafem
ale
impo
tencymenses
DaturametelLKU
H-858
Barbaka
Shrub
Perenn
ial
Who
leplant
KarakBa
nnu
Gon
orrhea
Tamaricaceae
Tamarixaphylla
(L)HK
arst
KUH-859
Sheengh
azz
Tree
Perenn
ial
Leavesbark
KarakBa
nnu
Gyn
ae
Verbenaceae
Verbenaoffi
cinalisLKU
H-860
Koso
beeta
Herb
Perenn
ial
Who
leplant
Bann
uMalakand
Pregnancymenses
6 BioMed Research International
Table 2 General attributes of medicinal plants
Attribute Total number Percentage ()Part use
Leaves 16 313Whole plant 17 333Fruit 10 192Bark 6 115Root 5 96Stem 4 76Seed 4 76Flower 1 19
HabitHerb 31 59Shrub 7 134Trees 14 269
ReproductionAnnual 9 173Biennial 2 38Perennial 41 788
02468
101214161820
Num
ber o
f pla
nts
Abor
tion
Impo
tenc
y
Mas
titis
Leuc
orrh
oea
Abor
tifac
ient
Gyn
ae
Preg
nanc
y
Gon
orrh
ea
Men
ses
Gynaecological problems
Figure 3 Number of plants used to treat gynaecological problems
regions used different plant parts for the recipe preparationbut whole plant and leaves (33 and 31 resp) were foundto be the most frequent parts used against gynaecologicalcomplaints (Table 2) Nine types of gynaecological ailmentswere treated in study areas Majority of the plants (19) werefound to be used against menses followed by 11 plants eachfor gonorrhea and pregnancy related problems (Figure 3) Ficresults showed that all plants in different areas scored highconsensus ranges between 06 and 100 (Table 3) Majorityof the female respondents (44) were aged between 61 and70 years Total of 40 informants were illiterate followed by38 who had just primary level of education Majority of thefemales (86) interviewed were housewives followed by 14school teachers (Table 4)
4 Discussion
Present study results showed that women of studied remoteareas of Pakistan have strong traditional knowledge in theutilization of medicinal plants for variety of gynaecologi-cal disorders Traditionally the rural women prefer plantmedicines rather than modern medicine for their personalailments due to lack of modern facilities in the regionsAmong all studied regions Bannu was ranked first havinglarge number of gynaecological plants High number ofmedicinal plants in the region might be associated withthe prevalence of large number of gynaecological problemsin the Bannu region Nine types of ailments were foundtreated using ethnomedicines in Bannu region It is a waraffected region of Pakistan where traditional medicines useis a common practice [9] Karak and Malakand regions alsocontain considerable number of gynaecological plants due tothe greater plant diversity in the regions rural nature anddependency of women for their primary health care needs[11 19]
The women of the studied regions mostly use herbs(59) for the preparation of ethnomedicines followed bytrees (269) In most remote areas medicinal herbs arethe main ingredients of local medicines and consideredthe main lifeline and frequently first choice The highestuse of herbs gives an indication of the presence of greatabundance of herb species as noticed during field visits thatareas very close to houses were well covered with herbs andcenturies old traditional knowledge of the healers Commonuse of herbaceous plants has also been reported from otherregions of Pakistan [2 20] and parts of the world [21 22]Herbs can grow in variety of places like roadsides homegardens farmland wild habitats and foundmore common incomparison to other growth forms The highest tree speciesutilization might be associated with their potential to surviveeven during long dry seasons thus their abundance andavailability throughout the year is higher in arid and semiaridareas The findings are in line with some studies [10 23]while being contradictory with studies conducted elsewherewhere shrubs were more frequently used [24 25] Variationin medicinal plants growth form might be associated withdifferent sociocultural beliefs ecological status and variationin practices of traditional healers of different regions orcountries Women mostly use perennial plants (78) for thetreatment of gynaecological problems The reason behindusing perennial plants might be due to the fact that highnumber of herbs and trees in the studied regions are perennialin their reproduction status
Women of studied regions use reported medicinal plantsfor the treatment of nine types of gynaecological ailmentsMenses was found to be the most treated ailment in thestudied regions Total of 19 plants were used to treat mensesrelated problems followed by 11 plants each for gonorrhea andpregnancy 10 for gynae 6 for abortifacient 5 for leucorrheaand 2 plants each for mastitis and impotency and singleplant is used for abortion Higher plant utilization for mensesmight be due to natural phenomenon associated with varietyof complications such as abdominal or pelvic cramping
BioMed Research International 7
Table 3 Fic values of traditional medicinal plants for treating gynaecological problems in study regions
Gynaecological problems Bannu Karak Kohat Chitral Mansehra MalakandMenses 088 091 100 087 mdash 097Gonorrhea 091 093 083 mdash 092 092Mastitis 100 100 100 mdash mdash 100Pregnancy 094 081 mdash 090 072 072Leucorrhoea 091 096 082 mdash 092 100Abortion 100 mdash mdash mdash mdash mdashGynae 082 052 075 072 063 061Female impotency 091 093 mdash mdash 100 100
Table 4 Ethnographic data of study regions
Ethnographic characters Bannu Karak Malakand Chitral Mansehra Kohat PercentageAge groups
40ndash50 6 5 7 4 5 4 1051ndash60 15 12 13 12 10 10 2461ndash70 20 22 21 23 20 26 4471ndash80 9 11 9 11 15 10 22
EducationIlliterate 22 19 23 17 19 20 40Primary 18 22 20 14 19 19 38Middle 5 6 2 9 6 6 11Secondary 3 2 3 6 4 4 7University 2 1 2 4 2 1 4
OccupationHousewives 43 39 46 47 41 43 86Teachers 7 11 4 3 9 7 14
lower back pain bloating and sore breasts food cravingsmood swings and irritability headache and fatigue [2627] Different plants have been found effective in relievingmenses complications like Justicia adhatoda Schinus molleConvolvulus arvensis Cyperus rotundus and Hypericum per-foratum Rural women use different parts of plant to prepareethnomedicines however use of specific plant part dependsupon plant habit and user requirements Traditional healersmostly prefer leaves and whole plant for the formulation ofgynaecological recipes The selection of specific plant partssuggests that these parts have strong healing potential againstgynaecological disorders but these parts need phytochemicalscreening and pharmacological investigation in order tocross-check traditional knowledge Present findings are inline with other studies showing leaves and whole plants asthe most frequently used plant parts for the preparation ofdifferent ethnomedicines [21 22 28] Whole plant harvestingis considered a destructive type of harvesting and causespopulation reduction of plant species
Most of the plants were found used in more than oneregion for the same particular ailment for example Con-volvulus arvensis was used against menses complication inBannu Kohat Karak and Malakand Melia azadirachta wasfound to be effective against gonorrhea in Bannu and KarakSolanum surattense was being used against gonorrhea andpregnancy in Malakand Bannu and Kohat Such types of
resemblance using similar plants for the same type of ailmentsin different cultures or regions provide a strong signal ofbioactivity potential of the documented plant species Infor-mant consensus results showed high consensus values rangesbetween 06 and 100 for 9 disease categories in different areasHigh Fic values in these regions indicate high prevalence ofgiven gynaecological problems in these regions Accordingto Heinrich et al [17] high Fic values are very useful inthe selection of specific plants for further search of bioactivecompounds Most of the diseases were found to be treatedwith only one or two plants in the studied regions and theirFic score was also high 100 Such plants should furtherbe analyzed for their phytochemical and pharmacologicalinvestigation
Ethnographic data showed that majority of the females(44) interviewed were aged between 61 and 70 years Theseresults clearly indicate that traditional knowledge is restrictedto aged people in these regions due to least interest ofyounger generation Total of 40 informants were illiteratein these regions followed by 38 who had only primary levelof education Only 4 respondents had university level ofeducation which reflects the unavailability of standard edu-cational institutions in these areas Literate people had lessknowledge about medicinal plants as compared to illiteratepeople of the regions due to modernization and changing lifestyles Total of 86 women were housewives while only 14
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
6 BioMed Research International
Table 2 General attributes of medicinal plants
Attribute Total number Percentage ()Part use
Leaves 16 313Whole plant 17 333Fruit 10 192Bark 6 115Root 5 96Stem 4 76Seed 4 76Flower 1 19
HabitHerb 31 59Shrub 7 134Trees 14 269
ReproductionAnnual 9 173Biennial 2 38Perennial 41 788
02468
101214161820
Num
ber o
f pla
nts
Abor
tion
Impo
tenc
y
Mas
titis
Leuc
orrh
oea
Abor
tifac
ient
Gyn
ae
Preg
nanc
y
Gon
orrh
ea
Men
ses
Gynaecological problems
Figure 3 Number of plants used to treat gynaecological problems
regions used different plant parts for the recipe preparationbut whole plant and leaves (33 and 31 resp) were foundto be the most frequent parts used against gynaecologicalcomplaints (Table 2) Nine types of gynaecological ailmentswere treated in study areas Majority of the plants (19) werefound to be used against menses followed by 11 plants eachfor gonorrhea and pregnancy related problems (Figure 3) Ficresults showed that all plants in different areas scored highconsensus ranges between 06 and 100 (Table 3) Majorityof the female respondents (44) were aged between 61 and70 years Total of 40 informants were illiterate followed by38 who had just primary level of education Majority of thefemales (86) interviewed were housewives followed by 14school teachers (Table 4)
4 Discussion
Present study results showed that women of studied remoteareas of Pakistan have strong traditional knowledge in theutilization of medicinal plants for variety of gynaecologi-cal disorders Traditionally the rural women prefer plantmedicines rather than modern medicine for their personalailments due to lack of modern facilities in the regionsAmong all studied regions Bannu was ranked first havinglarge number of gynaecological plants High number ofmedicinal plants in the region might be associated withthe prevalence of large number of gynaecological problemsin the Bannu region Nine types of ailments were foundtreated using ethnomedicines in Bannu region It is a waraffected region of Pakistan where traditional medicines useis a common practice [9] Karak and Malakand regions alsocontain considerable number of gynaecological plants due tothe greater plant diversity in the regions rural nature anddependency of women for their primary health care needs[11 19]
The women of the studied regions mostly use herbs(59) for the preparation of ethnomedicines followed bytrees (269) In most remote areas medicinal herbs arethe main ingredients of local medicines and consideredthe main lifeline and frequently first choice The highestuse of herbs gives an indication of the presence of greatabundance of herb species as noticed during field visits thatareas very close to houses were well covered with herbs andcenturies old traditional knowledge of the healers Commonuse of herbaceous plants has also been reported from otherregions of Pakistan [2 20] and parts of the world [21 22]Herbs can grow in variety of places like roadsides homegardens farmland wild habitats and foundmore common incomparison to other growth forms The highest tree speciesutilization might be associated with their potential to surviveeven during long dry seasons thus their abundance andavailability throughout the year is higher in arid and semiaridareas The findings are in line with some studies [10 23]while being contradictory with studies conducted elsewherewhere shrubs were more frequently used [24 25] Variationin medicinal plants growth form might be associated withdifferent sociocultural beliefs ecological status and variationin practices of traditional healers of different regions orcountries Women mostly use perennial plants (78) for thetreatment of gynaecological problems The reason behindusing perennial plants might be due to the fact that highnumber of herbs and trees in the studied regions are perennialin their reproduction status
Women of studied regions use reported medicinal plantsfor the treatment of nine types of gynaecological ailmentsMenses was found to be the most treated ailment in thestudied regions Total of 19 plants were used to treat mensesrelated problems followed by 11 plants each for gonorrhea andpregnancy 10 for gynae 6 for abortifacient 5 for leucorrheaand 2 plants each for mastitis and impotency and singleplant is used for abortion Higher plant utilization for mensesmight be due to natural phenomenon associated with varietyof complications such as abdominal or pelvic cramping
BioMed Research International 7
Table 3 Fic values of traditional medicinal plants for treating gynaecological problems in study regions
Gynaecological problems Bannu Karak Kohat Chitral Mansehra MalakandMenses 088 091 100 087 mdash 097Gonorrhea 091 093 083 mdash 092 092Mastitis 100 100 100 mdash mdash 100Pregnancy 094 081 mdash 090 072 072Leucorrhoea 091 096 082 mdash 092 100Abortion 100 mdash mdash mdash mdash mdashGynae 082 052 075 072 063 061Female impotency 091 093 mdash mdash 100 100
Table 4 Ethnographic data of study regions
Ethnographic characters Bannu Karak Malakand Chitral Mansehra Kohat PercentageAge groups
40ndash50 6 5 7 4 5 4 1051ndash60 15 12 13 12 10 10 2461ndash70 20 22 21 23 20 26 4471ndash80 9 11 9 11 15 10 22
EducationIlliterate 22 19 23 17 19 20 40Primary 18 22 20 14 19 19 38Middle 5 6 2 9 6 6 11Secondary 3 2 3 6 4 4 7University 2 1 2 4 2 1 4
OccupationHousewives 43 39 46 47 41 43 86Teachers 7 11 4 3 9 7 14
lower back pain bloating and sore breasts food cravingsmood swings and irritability headache and fatigue [2627] Different plants have been found effective in relievingmenses complications like Justicia adhatoda Schinus molleConvolvulus arvensis Cyperus rotundus and Hypericum per-foratum Rural women use different parts of plant to prepareethnomedicines however use of specific plant part dependsupon plant habit and user requirements Traditional healersmostly prefer leaves and whole plant for the formulation ofgynaecological recipes The selection of specific plant partssuggests that these parts have strong healing potential againstgynaecological disorders but these parts need phytochemicalscreening and pharmacological investigation in order tocross-check traditional knowledge Present findings are inline with other studies showing leaves and whole plants asthe most frequently used plant parts for the preparation ofdifferent ethnomedicines [21 22 28] Whole plant harvestingis considered a destructive type of harvesting and causespopulation reduction of plant species
Most of the plants were found used in more than oneregion for the same particular ailment for example Con-volvulus arvensis was used against menses complication inBannu Kohat Karak and Malakand Melia azadirachta wasfound to be effective against gonorrhea in Bannu and KarakSolanum surattense was being used against gonorrhea andpregnancy in Malakand Bannu and Kohat Such types of
resemblance using similar plants for the same type of ailmentsin different cultures or regions provide a strong signal ofbioactivity potential of the documented plant species Infor-mant consensus results showed high consensus values rangesbetween 06 and 100 for 9 disease categories in different areasHigh Fic values in these regions indicate high prevalence ofgiven gynaecological problems in these regions Accordingto Heinrich et al [17] high Fic values are very useful inthe selection of specific plants for further search of bioactivecompounds Most of the diseases were found to be treatedwith only one or two plants in the studied regions and theirFic score was also high 100 Such plants should furtherbe analyzed for their phytochemical and pharmacologicalinvestigation
Ethnographic data showed that majority of the females(44) interviewed were aged between 61 and 70 years Theseresults clearly indicate that traditional knowledge is restrictedto aged people in these regions due to least interest ofyounger generation Total of 40 informants were illiteratein these regions followed by 38 who had only primary levelof education Only 4 respondents had university level ofeducation which reflects the unavailability of standard edu-cational institutions in these areas Literate people had lessknowledge about medicinal plants as compared to illiteratepeople of the regions due to modernization and changing lifestyles Total of 86 women were housewives while only 14
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
BioMed Research International 7
Table 3 Fic values of traditional medicinal plants for treating gynaecological problems in study regions
Gynaecological problems Bannu Karak Kohat Chitral Mansehra MalakandMenses 088 091 100 087 mdash 097Gonorrhea 091 093 083 mdash 092 092Mastitis 100 100 100 mdash mdash 100Pregnancy 094 081 mdash 090 072 072Leucorrhoea 091 096 082 mdash 092 100Abortion 100 mdash mdash mdash mdash mdashGynae 082 052 075 072 063 061Female impotency 091 093 mdash mdash 100 100
Table 4 Ethnographic data of study regions
Ethnographic characters Bannu Karak Malakand Chitral Mansehra Kohat PercentageAge groups
40ndash50 6 5 7 4 5 4 1051ndash60 15 12 13 12 10 10 2461ndash70 20 22 21 23 20 26 4471ndash80 9 11 9 11 15 10 22
EducationIlliterate 22 19 23 17 19 20 40Primary 18 22 20 14 19 19 38Middle 5 6 2 9 6 6 11Secondary 3 2 3 6 4 4 7University 2 1 2 4 2 1 4
OccupationHousewives 43 39 46 47 41 43 86Teachers 7 11 4 3 9 7 14
lower back pain bloating and sore breasts food cravingsmood swings and irritability headache and fatigue [2627] Different plants have been found effective in relievingmenses complications like Justicia adhatoda Schinus molleConvolvulus arvensis Cyperus rotundus and Hypericum per-foratum Rural women use different parts of plant to prepareethnomedicines however use of specific plant part dependsupon plant habit and user requirements Traditional healersmostly prefer leaves and whole plant for the formulation ofgynaecological recipes The selection of specific plant partssuggests that these parts have strong healing potential againstgynaecological disorders but these parts need phytochemicalscreening and pharmacological investigation in order tocross-check traditional knowledge Present findings are inline with other studies showing leaves and whole plants asthe most frequently used plant parts for the preparation ofdifferent ethnomedicines [21 22 28] Whole plant harvestingis considered a destructive type of harvesting and causespopulation reduction of plant species
Most of the plants were found used in more than oneregion for the same particular ailment for example Con-volvulus arvensis was used against menses complication inBannu Kohat Karak and Malakand Melia azadirachta wasfound to be effective against gonorrhea in Bannu and KarakSolanum surattense was being used against gonorrhea andpregnancy in Malakand Bannu and Kohat Such types of
resemblance using similar plants for the same type of ailmentsin different cultures or regions provide a strong signal ofbioactivity potential of the documented plant species Infor-mant consensus results showed high consensus values rangesbetween 06 and 100 for 9 disease categories in different areasHigh Fic values in these regions indicate high prevalence ofgiven gynaecological problems in these regions Accordingto Heinrich et al [17] high Fic values are very useful inthe selection of specific plants for further search of bioactivecompounds Most of the diseases were found to be treatedwith only one or two plants in the studied regions and theirFic score was also high 100 Such plants should furtherbe analyzed for their phytochemical and pharmacologicalinvestigation
Ethnographic data showed that majority of the females(44) interviewed were aged between 61 and 70 years Theseresults clearly indicate that traditional knowledge is restrictedto aged people in these regions due to least interest ofyounger generation Total of 40 informants were illiteratein these regions followed by 38 who had only primary levelof education Only 4 respondents had university level ofeducation which reflects the unavailability of standard edu-cational institutions in these areas Literate people had lessknowledge about medicinal plants as compared to illiteratepeople of the regions due to modernization and changing lifestyles Total of 86 women were housewives while only 14
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
8 BioMed Research International
of females were school teachers that might be due to the factthat in remote areas of Pakistan women are mostly confinedto homes due to variety of customs and religious restrictionsIn rural areas girls are supposed to be future wives mothersand housekeepers little attention is given to their formaleducation Rural women have little access to educationparticularly at higher levels Even at the primary and sec-ondary levels access is restricted retention rates are low andfacilities particularly in rural areas remain abysmal Womenare poorly represented in higher and technical education andthus have poor employment prospects The women do notget sufficient medical treatment due to unavailability of themedical facilities Low literacy rate lack of medical facilitiesand low income of the people are the main factors for theirgreater dependency on medicinal plants
5 Conclusions
The present study concluded that women in remote areasof Pakistan have great dependency on medicinal plants forthe treatment of different gynaecological problems Studiedregions contain considerable number of medicinal plantsused by the traditional healers in different herbal formu-lations Menses and gonorrhea were found to be the mostprevalent complications in the studied region Plants scoringhigh Fic value should be further evaluated for their phyto-chemical and pharmacological investigation Ethnogynaeco-logical knowledge is only restricted to aged women whileyoung generation is totally ignorant Young girls should beeducated regarding the importance of traditional knowledgeMoreover detailed studies on ethnogynaecological plantsshould be carried out before the extinction of this valuableknowledge
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper
Authorsrsquo Contribution
Muhammad Adnan and Akash Tariq have designed theresearch project Akash Tariq Sakina Mussarat and ShaheenBegum conducted field work and collected ethnomedicinaldata After collection of data these authors analyzed the dataand prepared the whole paper Muhammad Adnan AkashTariq Riaz Ullah and Naser M AbdElsalam supervised allthe stages and provided comments on the draft All authorshave read and approved the final paper
Acknowledgments
The authors are thankful to the Deanship of Scientific Re-search King Saud University Riyadh Saudi Arabia for fund-ing the work through the Research Group Project no RGP-210 The authors offer special thanks to the local respondentsfor sharing their valuable knowledge
References
[1] B Sandhya S Thomas W Isabel and R Shenbagarathai ldquoEth-nomedical plants used by the Valaiyan community of Piran-malai Hills (Reserved Forest) Tamilnadu Indiamdasha pilot studyrdquoAfrican Journal of Traditional Complementary and AlternativeMedicines vol 3 no 1 pp 101ndash114 2006
[2] Z K Shinwari ldquoMedicinal plants research in Pakistanrdquo Journalof Medicinal Plant Research vol 4 pp 161ndash176 2010
[3] D C Deka V Kumar C Prasad et al ldquoOroxylum indicummdashamedicinal plant of North East India an overview of itsnutritional remedial and prophylactic propertiesrdquo Journal ofApplied Pharmaceutical Science vol 3 no 4 pp S104ndashS1122013
[4] E Nasir and S I Ali ldquoFlora of west Pakistanrdquo Tech Rep 1-190Pakistan Agriculture Research Council Islamabad Pakistan1971ndash1991
[5] A H M Rahman ldquoEthno-gynecological study of tradi-tional medicinal plants used by santals of Joypurhat DistrictBangladeshrdquo Biomedicine and Biotechnology vol 2 pp 10ndash132014
[6] C K Kaingu J A Oduma and T I Kanui ldquoPractices of tradi-tional birth attendants in Machakos District Kenyardquo Journal ofEthnopharmacology vol 137 no 1 pp 495ndash502 2011
[7] R A Qureshi M Ghufran S A Gilani A G Yousaf and ABatool ldquoIndigenous medicinal plants used by local women insouthern Himalayan regions of Pakistanrdquo Pakistan Journal ofBotany vol 41 no 1 pp 19ndash25 2009
[8] R B Tareen T Bibi M A Khan M Ahmad and M ZafarldquoIndigenous knowledge of folk medicine by the women of Kalatand Khuzdar regions of Balochistan Pakistanrdquo Pakistan Journalof Botany vol 42 no 3 pp 1465ndash1485 2010
[9] M Adnan I Ullah A Tariq et al ldquoEthnomedicine use in thewar affected region of northwest Pakistanrdquo Journal of Ethnobi-ology and Ethnomedicine vol 10 no 1 article 16 2014
[10] W Murad A Azizullah M Adnan et al ldquoEthnobotanicalassessment of plant resources of Banda Daud Shah DistrictKarak Pakistanrdquo Journal of Ethnobiology and Ethnomedicinevol 9 no 1 article 77 2013
[11] H ul HassanWMurad A Tariq andA Ahmad ldquoEthnoveteri-nary study of medicinal plants in Malakand Valley District Dir(Lower) Khyber Pakhtunkhwa Pakistanrdquo Irish Veterinary Jour-nal vol 67 article 6 2014
[12] I Ilahi ldquoEthnobotanical studies and problems associated withregeneration of herbals in kohat regionrdquo Pakistan Journal ofBotany vol 40 no 4 pp 1743ndash1753 2008
[13] S Shinwari R Qureshi and E Baydoun ldquoEthnobotanical studyof Kohat Pass (Pakistan)rdquo Pakistan Journal Botany vol 43 pp135ndash139 2011
[14] F Hadi A Razzaq A Rahman and A Rashid ldquoEthnobotanicalnotes onwoody plants of RechValley TorkhowDistrict ChitralHindu-Kush range Pakistanrdquo Scholarly Journal of AgriculturalScience vol 3 no 11 pp 468ndash472 2013
[15] M Giday T Teklehaymanot A Animut and Y MekonnenldquoMedicinal plants of the Shinasha Agew-awi and Amharapeoples in northwest Ethiopiardquo Journal of Ethnopharmacologyvol 110 no 3 pp 516ndash525 2007
[16] R T Trotter and M H Logan ldquoInformants consensus a newapproach for identifying potentially effective medicinal plantsrdquoin Plants in Indigenous Medicine and Diet N L Etkin Ed pp91ndash112 Redgrave Bedford Hill NY USA 1986
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013
BioMed Research International 9
[17] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998
[18] M Canales T Hernandez J Caballero et al ldquoInformantconsensus factor and antibacterial activity of the medicinalplants used by the people of San Rafael Coxcatlan PueblaMexicordquo Journal of Ethnopharmacology vol 97 no 3 pp 429ndash439 2005
[19] MKhan andFHussain ldquoConservation status of plant species inTehsil Takht-eNasrati District Karak Khyber PakhtunKhawaPakistanrdquo International Journal of Biodiversity and Conserva-tion vol 5 pp 20ndash26 2013
[20] N Khan M Ahmed A Ahmed et al ldquoImportant medicinalplants of Chitral Gol National Park (CGNP) Pakistanrdquo PakistanJournal of Botany vol 43 no 2 pp 797ndash809 2011
[21] CMuthuM Ayyanar N Raja and S Ignacimuthu ldquoMedicinalplants used by traditional healers in Kancheepuram District ofTamil Nadu Indiardquo Journal of Ethnobiology and Ethnomedicinevol 2 article 43 2006
[22] C P Kala ldquoEthnomedicinal botany of the Apatani in theEasternHimalayan region of Indiardquo Journal of Ethnobiology andEthnomedicine vol 1 article 11 2005
[23] AMaroyi ldquoTraditional use of medicinal plants in south-centralZimbabwe review and perspectivesrdquo Journal of Ethnobiologyand Ethnomedicne vol 9 article 31 2011
[24] M J Moshi D F Otieno and A Weisheit ldquoEthnomedicine ofthe Kagera Region north western Tanzania Part 3 plants usedin traditional medicine in Kikuku village Muleba DistrictrdquoJournal of Ethnobiology and Ethnomedicine vol 8 article 142012
[25] S B Padal Y Vijayakumar R J Butchi and P ChandrasekharldquoEthnomedicinal uses of Shrub species by tribals of BorraPanchayat Ananthagiri Mandalam Visakhapatnam districtAndhra Pradesh Indiardquo International Journal of PharmaceuticalScience Invention vol 2 pp 10ndash12 2013
[26] P Sharma C Malhotra D K Taneja and R Saha ldquoProblemsrelated to menstruation amongst adolescent girlsrdquo Indian Jour-nal of Pediatrics vol 75 no 2 pp 125ndash129 2008
[27] K Yamamoto A Okazaki Y Sakamoto and M Funatsu ldquoTherelationship between premenstrual symptoms menstrual painirregular menstrual cycles and psychosocial stress amongJapanese college studentsrdquo Journal of Physiological Anthropol-ogy vol 28 no 3 pp 129ndash136 2009
[28] J A Bhat M Kumar and R W Bussmann ldquoEcological statusand traditional knowledge of medicinal plants in KedarnathWildlife Sanctuary of Garhwal Himalaya Indiardquo Journal ofEthnobiology and Ethnomedicine vol 9 no 1 article 1 2013