Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎

1 Contents lists available at ScienceDirect 2 3 4 5 6 journal homepage: www.elsevier.com/locate/jep 7 8 9 10 11 12 13 14 15 Q1 Hassan Sher a,f, Ali Aldosari b,f, Ahmad Ali a,f, Hugo J. de Boer c,d,e,f,n 16 a Center for Plant Sciences and Biodiversity, University of Swat, Khyber Pakhtunkhwa, Pakistan 17 b Department of Geography, College of Arts, King Saud University, Riyadh, Saudi Arabia 18 c Center for Plant Sciences and Biodiversity, University of Swat, Khyber Pakhtunkhwa, Pakistan d 19 Department of Organismal Biology, Uppsala University, Sweden e 20 Naturalis Biodiversity Center, Leiden, The Netherlands f Natural History Museum, University of Oslo, Norway 21 22 23 art ic l e i nf o a b s t r a c t 24 25 Article history: Ethnopharmacological relevance: Mapping ethnomedicinal plants and associated indigenous knowledge 26 Received 4 December 2014 of folk medicines can provide a comprehensive overview of individual herbs employed in health care. 27 Received in revised form Reliance on medicinal plants in remote parts of northern Pakistan is high, especially among women, but 28 2 March 2015 no research has investigated specifically which plants are used. This study investigated indigenous 29 Accepted 6 March 2015 knowledge of folk medicines among tribal minorities in selected sites in upper Swat, Buner and Chitral 30 Districts in Khyber Pakhtunkhwa Province. 31 Keywords: Materials and methods: Interviews were conducted with gender-specific focus groups using question32 Medicinal plants naires and standardized data sheets, followed by forest walks in each of the visited areas. General Local trade 33 medicinal herb use, preparations, storage, marketing and collection habits for each gender group were Women's traditional knowledge 34 ascertained from the questionnaires. Subsistence livelihoods 35 Results: In total 168 women and 390 men were interviewed and provided information on 127 different Biological conservation shared medicinal species. Species use consensus among the informants ranged from 2.3% to 83.3%, with 36 Socio-economic development Cynodon dactylon, Avena sativa, Celtis australis, Datura stramonium, Solanum nigrum, Skimmia laureola, 37 Spirea nervosa, Ziziphus jujuba, Rumex hastatus, Plantago lanceolata, Lathyrus aphaca and Ficus palmata 38 having the highest reported consensus. The survey also revealed that a number of medicinal species were 39 exploited by the community for both marketing and personal use, and many of these species were 40 reported as being rare, vulnerable or even endangered. 41 Conclusions: The results revealed that women in all the three districts were important custodians of 42 medicinal plant knowledge, but elder women in general and the women from Buner district in particular 43 had a superior understanding of folk medicine. The forest walks revealed that women's traditional 44 medicinal knowledge was based on a more limited diversity of plant species. People in tribal 45 communities have an expressed interest in learning efficient techniques for medicinal plant collection, 46 preparation, storage and cultivation advice, and to learn more about the potential of marketing medicinal herbs and ways to reach local market centers. Education and awareness were considered to be essential 47 for improved health care and successful marketing. 48 & 2015 Published by Elsevier Ireland Ltd. 49 50 51 52 53 1. Introduction practice in Pakistan for both men and women. The northern part of 54 Khyber Pakhtunkhwa Province is particularly rich in floristic 55 biodiversity, and commercial extraction of medicinal plants began Medicinal plant gathering and processing amongst local com56 here some 50 years ago, and continues to this day (Ahmad et al., munities for the preparation of herbal medicines is a centuries old 57 2014; Hamayun et al., 2006b, 2003b; Sher and Al-Yemeni, 2011; 58 Shinwari, 2010). A lack of clear custodianship, little understanding 59 n Q2 Corresponding author at: Department of Organismal Biology, Uppsala University, of sustainable management practices and knowledge of market 60 Sweden. Tel.: þ47 98126030. requirements, coupled with poor social status and economic 61 E-mail addresses: [email protected] (H. Sher), opportunities for gatherers and inadequate institutional [email protected] (A. Aldosari), [email protected] (A. Ali), 62 tures, place natural habitats and populations of medicinal plants [email protected] (H.J. de Boer). 63 64 http://dx.doi.org/10.1016/j.jep.2015.03.022 65 0378-8741/& 2015 Published by Elsevier Ireland Ltd. 66

Journal of Ethnopharmacology

Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan

Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

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H. Sher et al. / Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎

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at risk. Currently there is little evidence of the conservation of indigenous medicinal herb species within the area. Biotic pressure from population growth and resulting domestic activities are placing some species under threat (Lange, 2002; Olsen and Larsen, 2003; Sher et al., 2010). Gathering and processing of medicinal plants is largely a family occupation for low income groups. In particular, women play an important role in the gathering and processing of medicinal plants for use within the immediate family and local communities (Pfeiffer and Butz, 2005). At the same time, reliance on medicinal plants in remote northern Pakistan is high, especially among women, but no research has investigated specifically which plants are used. In many areas it has been noted that the role that medicinal plants play in the economy and health care of isolated rural communities is still poorly understood (Bhattarai et al., 2006). Other research has identified medical herb gathering and processing by rural women and their immediate family members, as a possible source of human and livestock health maintenance, and also as a source of cash income (Barirega, 2014; Sher, 2013). Herbal medicines, which include herbs, herbal preparations and herbal products, are the most widespread of traditional medicines (World Health Organization, 2008), and women their most frequent users (Hall et al., 2011; Murphy et al., 1999). Herbal medicines are used by women to treat a number of reproductive health problems, such as menstrual problems, infertility, discomforts and dysfunctions of pregnancy, labor and menopause (Beal, 1998). Research on the use of plants often focuses on male traditional healers, thus overlooking a wealth of knowledge that is held by women (Pfeiffer and Butz, 2005). Erosion and deterioration of traditional medical knowledge can be observed in many cultures and lead not only to a loss in biocultural diversity, but also diversity in alternatives for primary healthcare and lead for drug discovery (Farnsworth et al., 1985). Documenting the use of plants by ethnic minorities and tribal people is not only an important part in understanding and analyzing elements of traditional knowledge, but also a way to perpetuate knowledge at risk of being lost (de Boer and Cotingting, 2014). The aim of this survey among communities in areas of known medicinal plant occurrence was to make a quantitative study of ethnomedical knowledge. Moreover, the aim was to provide an insight into the unmonitored aspects of medicinal plants harvesting and their socio-economic influence. An applied approach focuses on finding ways of making herbal medicine more beneficial and effective for personal use at a community level, and profitable on a domestic and international scale. This study was initiated with the aim to shed light on what has been perceived as a window of opportunity to address the socio-economic situation of women gatherers, and the conservation of naturally occurring medicinal plants.

diverse array of formations ranging from various forest types to desert, along an altitudinal gradient covering more than 4000 m (Nüsser and Dickoré, 2002). The submontane vegetations are characterized by Olea ferruginea Wall. ex Aitch. and Quercus oblongata D.Don, and the montane by Pinus wallichiana A.B.Jacks., Abies pindrow (Royle ex D.Don) Royle, Picea smithiana (Wall.) Boiss. and Quercus semecarpifolia Sm. (Shinwari et al., 2006). Buner lies to the south east of Swat and is a series of plains and mountains, and is characterized by a lush and humid environment. Chitral can only be reached from Swat by air or by crossing the 3118 m high Lowarie Pass by jeep. This pass is blocked by snow during the colder months of the year (December to April). Chitral is separated from Afghanistan by the Hindukush mountain range and the area harbors the highest peak of the range, Tirichmir, at 7708 m (Shaw and Shaw, 1993). The valley is a contrast of snowcapped peaks, barren land, cultivated areas, and the brown waters of the Chitral River. The main ethnic groups in the Swat district today are Yousafzai Pathans, Kohistani and Gujars. The Yousafzai Pathans are the descendants of Ghazni Afghans. The Gujars and Kohistanis, who speak different dialects of Gujri, Garwi, Torwali, and Kohistani, inhabit the upper mountainous areas of the district (Sher et al., 2014). Chitral, Bunir and Swat were chosen based on information that communities in these areas were actively engaged in medicinal herb collection. These areas were also chosen due to their high elevation, variation in ecological zones, rich diversity of medicinal plants, strong forest plantation management system, and engaged local community groups. The selected communities were strategically located for the inclusion in, or targeting of, intensive protection and management schemes. 2.2. Survey procedure The survey was conducted over a four week period from July to August 2013 by a multi-disciplinary team comprising of a field social organizer, a medical herbalist, an ethnobotanist, and a sociologist. Throughout the survey the team was assisted by staff from other collaborating agencies, e.g. the Agha Khan FoundationChitral, and regional officers from the Agriculture Extension and Forest Departments. A survey questionnaire was devised to identify the knowledge of rural people and their immediate family about the collection of medicinal plants and their use within the community. This survey was unique in that it had a gender differentiated emphasis as recommended by Pfeiffer and Butz (2005). A medicinal herb data sheet was incorporated into the survey as a means of obtaining detailed information on all individual plant species that were mentioned as being commonly used. 2.3. The survey

2. Material and methods 2.1. Study site This study took place in Khyber Pakhtunkhwa Province in northwestern Pakistan, which accommodates the eastern Hindukush mountains. The three areas surveyed were Upper Swat, Buner and Chitral, which all lie in the Malakand Division of Khyber Pakhtunkhwa Province (Fig. 1). The area is known for its spectacular scenery encompassing the Swat River, fertile lands and contrasting mountains. A total of 1550 taxa of flowering plants are reported from Swat (Stewart, 1967). Altitude and exposure greatly modify the climatic conditions within the area, and it can be divided into five vegetation zones: alpine, sub-alpine, montane, sub-montane and sub-tropical. The vegetation includes a fairly

The interview procedure for the survey can be divided into four stages. Each village interview started with a general meeting, followed by female (group) interviews and male (group) interviews (de Boer and Lamxay, 2009), and ended with forest walks (Martin, 2004). Interviews were conducted in the native Pashto language, which was undemanding for both the informants and interview team. The general meeting was usually held in a local hujra (male meeting place) whenever possible, and was attended by all members of the survey team, male members of the community, resource person/s, and, on occasions, local hakims (traditional unani practitioner), collectors and sellers of medicinal herbs. Team members and their individual areas of expertise were introduced, together with the purpose of the study. This meeting was a very important aspect of the survey as it helped the men of the community to understand the purpose of the study, and

Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

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Fig. 1. Map showing studied sites (Districts) in Malakand division. Image by Dr. M. Masood, Abdul Wali Khan University.

subsequently to give their blessing and allow the facilitation of the female interviews. The female interviews were carried out as group interviews at allocated meeting places like houses, schools etc. by female interviewers as outlined by de Boer and Lamxay (2009) and de Boer et al. (2012). The interview began with a brief introduction of the team and the purpose for the study to gain the trust of the women, which allowed them to talk more freely and openly. A

total of 168 individual questionnaires with female informants were completed during the focus group discussion interviews. The survey team was supported, and escorted, in the field by a female social organizer and a female sociologist from University of Swat. The male interviews were actually an extension of the general meeting and took place after the female team members had departed, as suggested in de Boer and Lamxay (2009). A total of

Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

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390 individual questionnaires with male informants were completed during the focus group discussion interviews. The forest walks were conducted after the completion of the male and female interviews. Guided by selected male members of the community, the teams were shown the local habitat and availability of locally used medicinal herbs. The medicinal herb data sheets were completed to extract local information and to enable intergender comparison and triangulation of indigenous knowledge. Voucher specimens were collected of all species and available floras (Nasir and Ali, 1971) were used for identification. Herbarium vouchers were deposited at the National Herbarium at the Pakistan Agricultural Research Council (Index herbariorum code RAW) in Islamabad for verification of identifications by specialists. Voucher specimens of commercially important medicinal plant species were also deposited at the herbarium of Center for Plant Sciences and Biodiversity, University of Swat, Pakistan. Plant nomenclature follows The Plant List (2013) and family names are according to the Angiosperm Phylogeny Group III classification (APG, 2009). 2.4. Data analysis Species use reports were tallied for each use per species per gender following general methodology by Adu-Tutu et al. (1979) and the standards set by Heinrich et al. (2009). Table 1 presents the number of times each species use was reported by men and women. The frequencies are reported both as absolute numbers and relative numbers to correct for the different numbers of men and women interviewed. The relative species use consensus values were ordered and scatter-plotted using MS Excel to visualize their distribution and range (Fig. 2). Relative species use consensus values ranged from 6.0% to 83.3% for women, and 2.3% to 49.2% for men.

3. Results The study revealed that there were total 126 plant species and one mushroom belonging to 59 families (Table 1). The plant species belonged to 51 dicotyledonous families, three monocotyledons families, two gymnosperms families, and two pteridophytes families. The families with most reported species were Lamiaceae (7 spp.) and Rosaceae (6 spp.). Based on their growth habits, the reported species were classified into herbs (53), shrubs (12), trees (19), climbers (2) and fungi (1), and based on plant part used, the used parts were classified into whole plant, leaves, fruits, shoots, roots, barks, seeds and resins (Fig. 3). The total number of 126 used plant species out of a total plant diversity of 1550 taxa (Stewart, 1967) gives an ethnobotanicity index (EI), the quotient of the number of used plants from the total diversity (Portères, 1970), of 8.1%. The study indicates that the reported medicinal plants are used locally in traditional medicine systems to treat various health conditions. Some plants were used alone while many others were used in combination with other plants or foodstuffs. Similarly few plants species were considered for the treatment of only one specific disease while several other have multiple such uses. 3.1. Women participants The survey revealed that the dominant professions of the women surveyed were housewives and farmers. In Upper Swat the number of housewives and the number of farmers questioned were identical. In Buner and Chitral, the study showed that farming was the predominant profession, with housewives accounting for

only 3% and 18% respectively of the female respondents in each District. The mean average age of the surveyed women was 43 years old. The average age did not vary too extensively between Districts. In Upper Swat the average age was 42 years, in Buner 48 years, and in Chitral it was 39 years. Health and education services have not reached the remote parts of the middle hills area in Malakand. Finding women who relied completely on herbal medicine was a rare occurrence, and the majority of the visited households also sought advice of doctors and pharmacists. The use of orthodox medicine was apparent even in the remotest of areas, as empty tablet packages were often in evidence. The standard causes for using orthodox rather than herbal medicine were (in order of priority): surgery, accidents, births and serious illnesses. The study revealed that the availability of herbs and their efficacy also influenced the decision to opt for orthodox intervention. However, it was difficult to establish how effective traditional treatments of ailments really were. Results of the survey revealed that of the women interviewed, a very high percentage (96% in Upper Swat, 97% in Buner, 100% in Chitral) knew plants to treat certain medical conditions. The advice of family elders and Hakims was sought by between 9% and 36% of the women interviewed. The study also demonstrates the knowledge of women by showing the average number of medicinal plant known by each of them. The women of Amazai Valley in Buner District were found to have the most knowledge (an average of 69 herbs known by each woman interviewed) as compared to female respondents in Torkhow Valley, Chitral, who were only aware on average of 15 different species per person. Both children and adults were treated using herbal medicine in the areas visited. In Chitral District, all women interviewed used medicinal plants for children and adults, whereas in Upper Swat 79% of the interviewed women treated children and 89% treated adults. In Buner District, the figures were 95% and 97% respectively. 3.2. Local knowledge The results show that a total of 168 interviewed women reported 7466 species-uses and that a total of 390 men reported 11,108 species-uses in the interviews in Upper Swat, Buner and Chitral Districts. The survey recorded a total of 127 different species used for the treatment of human illnesses by the respondents. The forest walks provided the survey team with the opportunity to record herbs that were not mentioned during the interviews, but were found to be growing locally. The survey shows that, on average, the respondent women knew of 42 medicinal plant species around their village, and men knew 73 species on average. The 12 most commonly reported species-uses were for Cynodon dactylon (L.) Pers. as a decoction for nose bleeding (92 women; 162 men), Avena sativa L. as an aphrodisiac paste (112; 162), Celtis australis L. fruit against colic (105; 131), and amenorrhea (112; 152), Datura stramonium L. as a decoction of the roots to treat fevers (178; 151), and earaches (102; 182), Solanum nigrum L. fruit to treat fever (172; 192), Skimmia laureola (DC.) Siebold & Zucc. ex Walp. leaves in an infusion to cure dyspepsia (78; 162), Spirea nervosa Franch. & Sav. flowers in an infusion to ease child delivery (123; 156), Ziziphus jujuba Mill. fruits to treat cough and cold (123; 167), Rumex hastatus D.Don shoots as a refrigerant in cooling drinks (109; 126), Plantago lanceolata L. leaves in a poultice to treat sores and inflammations (140; 160), Lathyrus aphaca L. seed decoction as vulnerary (109;150), and Ficus palmata Forssk. fruit to improve digestion (132; 162). 3.3. Herbal medicine management Results obtained from the questionnaire facilitated the recording of the main collectors of medicinal herbs; the time spent gathering; when collection occurred; and whether indigenous or

Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 VSN

Family name

Botanical name

Habit

Local name (Pashto)

Part used

Local uses

Use Freq F

Fungi UOS101 Morchellaceae

Morchella esculenta Fr.

Fungi

Gujay

Fruiting body

Morels are fried with cow's ghee and eaten after dinner as 1) a general body tonic; and 2) an aphrodisiac.

1 2

10 18

25 37

6.0 10.7

Pteridophytes UOS103 Dryopteridaceae UOS102 Pteridaceae

Dryopteris juxtaposita Christ Adiantum venustum D.Don

Herb Herb

Kwanjay Sumbal

Fronds Fronds

It is used as a local vegetable and is believed to improve digestive power. 1 Extract from the leaves are mixed with an extract of the root of Cichorium intybus and is used to 1 treat fever, backache and also as a blood purifier.

45 40

53 50

26.8 13.6 23.8 12.8

Gymnosperm UOS103 Pinaceae UOS104 Pinaceae

Pinus wallichiana A.B.Jacks. Tree Picea smithiana (Wall.) Boiss. Tree

Srap (peoch) Resin Kandal Leaves (Managazai) Banrraya Bark

Resin (3–4 drops) is mixed with mustard oil and applied to ruptured skin as a healing agent. An infusion of the fresh leaves is used once in a day for one week to 1) remove kidney stones; and 2) treat rheumatism. Powdered bark is used with a cup of milk orally as emmenagogue and antispasmodic

1 1 2 1

15 23 28 61

27 37 43 87

8.9 6.9 13.7 9.5 16.7 11.0 36.3 22.3

Ghaz meva (Asos) Chalwai

Fruit

Fresh mature fruits are eaten to cure stomach disorders

1

35

57

20.8 14.6

Shoots and leaves Leaves and bark

1) Leaves and shoots are boiled in water and the extract is used to treat cough and asthma. 2) Also 1 used as a local vegetable. 2

15 70

25 75

8.9 6.4 41.7 19.2

1) Powdered bark and leaves are taken with a glass of water before breakfast to treat jaundice. 2) 1 Also used as antiseptic. 2

11 23

41 26

6.5 10.5 13.7 6.7

Powdered fruit is mixed with sugar and is taken orally: 1) to treat stomachache; 2) as a carminative agent. 1) Powdered fruit is mixed with sugar and is taken with a cup of milk for curing of dysuria. 2) Dried fruits are used as a laxative. Flowers and leaves are taken in powdered form with a glass of water as antispasmodic and to treat stomachache. 1) The decoction of fresh root is mixed with sugar and is taken orally for the treatment of jaundice and fever. 2) It is also used in combination with powdered bark of Pistacia chinensis subsp. integerrima (J.L.Stewart ex Brandis) Rech.f. 1) Leaves are ground and are taken with a glass of milk as tonic. 2) Decoction of roots is used orally to cure the disorder of kidney and liver.

1 2 1 2 1

27 48 15 25 24

87 62 23 32 51

16.1 22.3 28.6 15.9 8.9 5.9 14.9 8.2 14.3 13.1

1 2

41 52

37 24

24.4 31.0

1 2

42 24

66 72

25.0 16.9 14.3 18.5

1 2 3 1

51 65 73 36

81 102 113 57

1

67

89

39.9 22.8

1 2 1 2

32 42 71 43

54 62 86 76

19.0 25.0 42.3 25.6

13.8 15.9 22.1 19.5

1 2 Shoots and leaves are eaten raw as a local vegetable for 1) stomachache; 2) and as an emollient. 1 2

105 112 34 56

131 152 61 72

62.5 66.7 20.2 33.3

33.6 39.0 15.6 18.5

UOS105 Taxaceae Angiosperm (Dicot) UOS118 Adoxaceae UOS106 Amaranthaceae

Taxus wallichiana Zucc.

Tree

Viburnum grandiflorum Wall. Shrub Ex DC Amaranthus viridis L. Herb

Shnai

Herb

Dhanial

Fruit

UOS109 Apiaceae

Foeniculum vulgare Mill.

Herb

Fruit

UOS110 Asteraceae

Artemisia vulgaris L.

Herb

Kaga Velanay Tarkha

UOS111 Asteraceae

Cichorium intybus L.

Herb

Han

UOS112 Asteraceae

Taraxacum officinale (L.) Weber ex F.H.Wigg.

Herb

Ziarr Gulay

UOS113 Berberidaceae

Berberis lycium Royle.

Shrub

Kwaray

UOS114 Brassicaceae

Herb

Bambesa

UOS115 Brassicaceae

Capsella bursa-pastoris (L.) Medik. Nasturtium officinale R.Br.

Herb

Talmira

UOS116 Buxaceae

Sarcococca pruniformis Lindl. Herb

Ladanrr

UOS117 Cannabaceae

Cannabis sativa L.

Herb

Bhang

UOS177 Cannabaceae

Celtis australis L.

Tree

Tagha

UOS119 Caryophyllaceae

Silene vulgaris (Moench) Garcke

Herbs

Bashka

UOS120 Caryophyllaceae

Stellaria media (L.) Vill.

Herb

Oulalai

UOS121 Chenopodiaceae UOS123 Convolvulaceae

Chenopodium album L. Convolvulus arvensis L.

Herb

Sarmay Prewathai

Young shoots Roots

Roots and leaves Stem and Powdered root bark is used: 1) as a tonic in nephrological complaints; 2) as an astringent in leaves gynecological disorders; and 3) to treat jaundice.

Stem and Fresh leaves are crushed into paste, and two table spoons are taken with milk to treat diarrhea. leaves Shoots Leaves and young shoots are boiled in water and are taken as a local vegetable for the treatment of constipation and stomachache. Leaves 1) Leaves heated in mustard oil are applied to muscular pains, twice a day. 2) Infusion of the leaves is taken orally to treat rheumatism. 1) The leaves are used in a poultice for wound healing. 2) In powdered form the leaves are taken Shoots orally twice a day as anodyne. and leaves Fruit Fruits are edible and are used to treat: 1) colic; and 2) amenorrhea. Shoots and leaves Whole plant Shoots

RF F

30.4 38.7 43.5 21.4

RF M

6.4 9.5

9.5 6.2

20.8 26.2 29.0 14.6

A decoction of plant is used as a purgative.

1

45

67

26.8 17.2

Shoots are cooked in milk, and are eaten with maize bread. A decoction of the plant is used as a hairwash to treat dandruff.

1 1

56 78

78 102

33.3 20.0 46.4 26.2

5

Tree

UOS108 Apiaceae

Pistacia chinensis subsp. integerrima (J.L.Stewart ex Brandis) Rech.f. Coriandrum sativum L.

UOS107 Anacardiaceae

Freq M

H. Sher et al. / Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎

Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

Table 1 Ethnopharmacology of medicinal plants reported by women in Khyber Pakhtunkhwa

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 6

VSN

Family name

Botanical name

Habit

UOS122 Convolvulaceae

Cuscuta reflexa Roxb.

UOS124 Ebenaceae

Diospyros lotus L.

Climbing herb Niladaria Climber (parasite) Tree Tor Amlook

Whole plant Whole plant Fruit

UOS125 Elaeagnaceae

Elaeagnus umbellata Thunb.

Shrub

Flowers

UOS126 Euphorbiaceae

Euphorbia helioscopia L.

Herb

Ghanam ranga Mandanroo

UOS127 Euphorbiaceae

Euphorbia wallichii Hook.f.

Herb

Shangla

UOS128 Fagaceae

Quercus incana Bartram

Tree

Banj

UOS129 Fagaceae

Tree

Toor Banj

Tree Herb

Mer (tarra) Srazela

UOS134 Hypericaceae

Quercus floribunda Lindl. ex A.Camus Quercus semicarpifolia Sm. Geranium wallichianum D. Don ex Sweet Hypericum perforatum L.

Herb

Shin chay

UOS135 Juglandaceae

Juglans regia L.

Tree

Ghuz

UOS136 Lamiaceae

Ajuga integrifolia Buch.-Ham. Herb

UOS137 Lamiaceae

Mentha longifolia (L.) L.

Herb

UOS138 Lamiaceae

Mentha spicata L.

Herb

UOS139 Lamiaceae

Herb Micromeria biflora (BuchHam. ex. D.Don) Benth. Salvia moorcroftiana Wall. ex Herb Benth. Thymus linearis Benth. Herb

UOS130 Fagaceae UOS132 Geraniaceae

UOS140 Lamiaceae UOS141 Lamiaceae UOS142 Lamiaceae UOS152 Leguminosae

Isodon rugosus (Wall. ex Shrub Benth.) Codd Indigofera heterantha Brandis Shrub

UOS153 Leguminosae UOS143 Malvaceae

Lathyrus aphaca L. Malva neglecta Wallr.

Herb Herb

UOS144 Meliaceae

Melia azedarach L.

Tree

UOS145 Moraceae

Ficus palmata Forssk.

Tree

UOS146 Moraceae UOS147 Myrsinaceae UOS148 Oleaceae

Morus alba L. Myrsine africana L. Olea ferruginea Wall. ex Aitch.

Tree Shrub Tree

Local name (Pashto)

Part used

Local uses

Use Freq F

The powdered plant is taken with a glass of milk twice a day after the meal for the treatment of diabetes. The fruits are boiled in milk and the decoction is taken orally twice daily to 1) cure dysentery; and 2) constipation. A decoction of flowers is used twice a day to combat heart problems, cough and chest pain.

1

58

98

34.5 25.1

1 2 1

78 52 77

105 82 78

46.4 26.9 31.0 21.0 45.8 20.0

1

56

89

33.3 22.8

1 2 1

82 92 87

104 102 99

48.8 26.7 54.8 26.2 51.8 25.4

1

64

83

38.1 21.3

1 1

76 56

109 102

45.2 27.9 33.3 26.2

1

24

36

14.3

9.2

1 2 Booti 1 2 3 Velanay Stem and 1) A decoction of the leaves is taken orally thrice a day to treat diarrhea in children. 2) Powdered 1 leaves plant is mixed with sugar and is eaten for the prevention of vomiting. 2 The powdered plant is taken orally with a glass of water early in the morning before breakfast to 1 Pudina Shoots 1) control vomiting; and 2) as a carminative. 2 and leaves Naray Whole Milkmen use it as an aromatic agent and wash their milk containers with it to avoid bad odor, 1 Shamakay plant bacterial growth and milk spoilage (Antiseptic). Khardag Stem and 1) Leaves are warmed with mustard oil and applied as a poultice on abscesses to release puss. 2) 1 leaves The inner part of the stem is chewed as an aphrodisiac. 2 Zangali Whole A green infusion is prepared from the leaves and stem to treat fevers, cough and cold. 1 Sperkai plant Sperkay Stem and Dried leaves are chewed against toothache. 1 (Butras) leaves 1) Dried powdered root is taken with a glass of water to cure scabies. 2) Powdered dried leaves are 1 Ghwareja Roots also taken with a glass of milk for stomach disorders. 2 and leaves Kurkamanay Seeds The decoction of the seed is applied three times a day for healing wounds 1 Zangali Leaves Leaves are eaten fresh and boiled to treat constipation and improve digestion. 1 Panerak 1 1) Fruits are dried, crushed and taken orally with milk for gastric troubles, fever and cough. 2) Leaves, Tora fruit and Powdered leaves are mixed with wheat flour and are used orally as anthelmintic, in livestock. 3) 2 Bakyanra 3 Decoction of the bark is considered to be an antiallergenic. bark (Shandai) Inzar Flowers 1) Flowers are taken orally as demulcent. 2) Fruits are edible and eaten to improve digestion. 1 and fruit 2 Toot Fruit Mature fruit is eaten to treat constipation, cough and cold. 1 Marurrang Fruit Ripe fruits are edible and chewed to treat toothache. 1 Khona 1 2

21 72 11 42 53 61 92 105 98

105 108 71 62 103 81 107 113 112

12.5 42.9 6.5 25.0 31.5 36.3 54.8 62.5 58.3

26.9 27.7 18.2 15.9 26.4 20.8 27.4 29.0 28.7

104

143

61.9 36.7

100 102 56

122 152 89

59.5 31.3 60.7 39.0 33.3 22.8

57

109

33.9 27.9

45 72

99 132

26.8 25.4 42.9 33.8

109 47

150 69

64.9 38.5 28.0 17.7

10 12 57 101 132 67 90 11 32

34 24 39 145 162 80 140 51 102

6.0 7.1 33.9 60.1 78.6 39.9 53.6 6.5 19.0

Roots It is considered as poisonous but hakims use it mixed in tablets with other plants as a laxative. and latex Shoots Dried leaves and seeds are given to children in small amounts to 1) treat in bowel complains; 2) remove ring worms. Fruit Powdered fruit is given to children before going to bed for curing of enuresis and dysuria, for a period of three weeks. Fruit Powdered fruit are used to treat gonorrhea and urinary tract infections. Powdered fruit are mixed with wheat flour and fried in desi ghee as a general body tonic. Root decoction in combination with pods of Pistacia chin. var. integerrima is used to treat kidney diseases, cough and fever. Leaves Locally a green infusion is prepared from the leaves and is considered as a stimulant and carminative agent. Fruit and 1) Mature fruit is used as a brain tonic. 2) The stem and root bark of stem is used as an antiseptic bark toothbrush (Dandasa). Whole A decoction of the plant or powder is taken before breakfast to treat 1) sore throats; 2) purifying plant blood; and 3) epilepsy. Fruit Roots

Freq M

RF F

RF M

8.7 6.2 10.0 37.2 41.5 20.5 35.9 13.1 26.2

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Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

Table 1 (continued )

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 1) Fresh leaf dectoction is used as a gargle to treat toothache and gum disorders. 2) Oil extracted 3 from fruits is applied externally to treat rheumatism. 3) Young shoots are used as an anitseptic toothbrush. Powdered root is taken orally with a glass of water before breakfast as anthelmintic medicine. 1 Decoction of plant is taken after meal to enhance digestion. 1

43

73

25.6 18.7

77 70

98 90

45.8 25.1 41.7 23.1

Powdered root is mixed with prepared halva of wheat flour and is taken with desi ghee, as a general body tonic. Powder of the whole plant is mixed with honey and milk and used 1) to treat jaundice; and 2) as blood purifier. 1) Dried capsule is boiled in tea, and is taken orally to cure cough, fever and headache. 2) Seeds are eaten as a general body tonic.

1

50

89

29.8 22.8

1 2 1 2

12 32 17 62

21 42 41 82

7.1 5.4 19.0 10.8 10.1 10.5 36.9 21.0

A poultice of crushed fresh leaves is used to treat sores and inflammations, particularly of the feet. Powdered dried bark is taken with a glass of milk twice a day to control diarrhea. Powdered root is mixed with sugar and is eaten with a glass of milk as a tonic (for women). Both the rhizome and leaves are crushed and are applied externally to wounds as healing agent.

1 1 1 1

140 45 67 89

160 67 80 108

83.3 26.8 39.9 53.0

1) The leaves are used as local vegetable, which enhances digestion. 2) The shoots are used as refrigerant in cooling drinks.

1 2

71 109

107 126

42.3 27.4 64.9 32.3

1 1

34 78

67 90

20.2 17.2 46.4 23.1

1 1

123 56

167 98

73.2 42.8 33.3 25.1

UOS149 Oleaceae UOS150 Oxalidaceae

Jasminum officinale L. Oxalis corniculata L.

Shrub Herb

Chambele Tarukay

UOS151 Paeoniaceae

Paeonia emodi Royle

Herb

UOS131 Papaveraceae

Herb

UOS154 Papaveraceae

Fumaria indica (Hausskn.) Pugsley Papaver somniferum L.

Mamekh (Warrd) Paprra

Herb

Qashqash (Apim)

UOS155 UOS156 UOS157 UOS158

Plantago lanceolata L. Platanus orientalis L. Polygonum aviculare L. Rumex dentatus L.

Herb Tree Herb Herb

Jabai Chinar Palpoolak Shalkhay

UOS159 Polygonaceae

Rumex hastatus D.Don

Herb

Tarukay

UOS160 Portulacaceae UOS161 Primulaceae

Portulaca oleracea L. Primula denticulata Sm.

Herbs Herb

Warkharray Mamera

Whole plant Capsule and seeds Leaves Bark Roots Roots and leaves Shoots and leaves Shoots Flowers

UOS162 Rhamnaceae UOS163 Rosaceae

Ziziphus jujuba Mill. Crataegus laevigata (Poir.) DC. Fragaria vesca L.

Tree Tree

Markhanrai Tampasa

Fruit Fruit

A decoction is taken before meal for the treatment of kidney and liver diseases. Powdered dried flowers are applied to eyes to control opthalmia, conjunctivitis, and to improve eyesight. Fruits are edible and used to treat cough and cold. Fruits are edible and used as a heart tonic.

Herb

Fruit

Fruits are edible and used to improve digestion as a carminative and laxative.

1

11

34

Prunus cornuta (Wall. ex Royle) Steud. Rosa moschata Herrm.

Tree

Zmakeen toot (Katal Meva) Changa

Fruit

Decoction of the fruit is taken after meal to enhance digestion.

1

34

78

20.2 20.0

Flowers

Decoction of fresh flowers is taken before breakfast to cure stomach disorders.

1

67

99

39.9 25.4

Fruit Flowers Leaves

Ripe fruit is eaten to control stomachache and to enhance digestion. Infusion of flowers is given to women to ease delivery. 1) Dried leaves are burnt to expel evils and evil eyes as it is considered as an antiseptic. 2) An infusion of the leaves is used after the meal to cure dyspepsia.

1 1 1 2

67 123 13 78

111 156 91 162

Bark Seeds

Decoction of bark is used twice a day after meal to cure stomachache. 1 1) Powdered fruits are eaten before breakfast and considered as anthelmintic. 2) Oil extract from 1 the fruit is externally applied to treat rheumatism. 2 Powdered root is taken with a glass of water as anti-diabetic and expectorant. 1

34 41 52 73

67 61 9 88

20.2 17.2 24.4 15.6 31.0 2.3 43.5 22.6

Fresh leaves are mixed with mustard oil and applied as poultice on swellings for its antimicrobial 1 activity. Oil is extracted from the ripe seeds to topically treat urticaria (larrama). 1

78

90

46.4 23.1

67

134

39.9 34.4

1 2 1 2 1 2

101 136 122 102 11 42

140 192 151 182 41 72

60.1 81.0 72.6 60.7 6.5 25.0

1 2

15 28

31 52

Plantaginaceae Platanaceae Polygonaceae Polygonaceae

UOS164 Rosaceae

UOS165 Rosaceae UOS166 Rosaceae

Shrub

UOS167 Rosaceae UOS168 Rosaceae UOS169 Rutaceae

Rubus vulgaris Weihe & Nees Shrub Spirea nervosa Franch. & Sav. Shrub Skimmia laureola (DC.) Herb Siebold & Zucc. ex Walp.

UOS170 Rutaceae UOS133 Sapindaceae

Zanthoxylum armatum DC. Aesculus indica (Wall. ex Cambess.) Hook. Berginia ciliata (Haw.) Sternb.

UOS171 Saxifragaceae

Shrub Tree Herb

UOS172 Scrophulariaceae Verbascum thapsus L.

Herb

UOS173 Simaroubaceae

Tree

Zangali Gulab (Khwrrach) Baganrra Krachay Namer (Nazar Panrra) Dambara Jawaz Makanrr path (Gat panrra) Khardag

UOS174 Solanaceae

Ailanthus altissima (Mill.) Swingle Solanum nigrum L.

Herb

Bakyanrra (Shandai) Karmachu

UOS175 Solanaceae

Datura stramonium L.

Herb

Harhanda

UOS176 Thymelaeaceae

Daphne mucronata Royle

Shrub

Laighunay

UOS178 Urticaceae

Urtica dioica L.

Herb

Seezunkay

Roots

Leaves Seeds

Fruit and 1) A paste of the leaves is applied to the skin to cure eczema. 2) The fruits are edible and are used leaves to cure fever. Roots 1) Decoction of roots is taken orally twice a day for a week to treat fever. 2) Drops of the decoction are applied to the ear to treat earache. 1) Infusion of the leaves is used to treat gonorrhea. 2) Decoction of roots is used before breakfast Roots as anthelmintic. and leaves Whole Used as a vegetable to treat 1) constipation; and 2) pulmonary diseases. plant

6.5

39.9 73.2 7.7 46.4

41.0 17.2 20.5 27.7

8.7

28.5 40.0 23.3 41.5

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Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

Leaves, fruit and bark Roots Whole plant Roots

35.9 49.2 38.7 46.7 10.5 18.5

8.9 7.9 16.7 13.3 7

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

H. Sher et al. / Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎

38.7 41.5 33.6 41.5 38.5 61.9 66.7 36.3 54.8 46.4

Fig. 3. Percentages of medicinal plant parts used in the studied area.

Jwar

VSN: voucher specimen number.

Zea mays L. UOS186 Poaceae

Herb

Kabal Herb Cynodon dactylon (L.) Pers. UOS185 Poaceae

UOS184 Poaceae

Fig. 2. Ordered relative species-use consensus values per gender.

Whole plant Seeds

104 112 61 92 78 Jamdaray Herb

Gandechar

Moraea sisyrinchium (L.) Ker Gawl. Avena sativa L. UOS183 Iridaceae

Herb

Fruit

Seed is fried in ghee and milk to create a paste that is considered as 1) general body tonic; and 2) a 1 male aphrodisiac. 2 Decoction of plant is used as 1) blood purifier; and 2) controlling bleeding from nose. 1 2 Maize flour is poured on fire in a small quantity to get fumigation, and skin with urticaria 1 (larrama) is exposed to the fumes as a treatment.

151 162 131 162 150

27.4 20.0 46 Decoction of corms is taken twice a day as a diuretic.

1

78

53.6 27.4 90

Whole plant Corms Ouga Allium sativum L. Angiosperm (Monocot) UOS182 Amaryllidaceae

Herb

Banafsha Viola pilosa Blume UOS181 Violaceae

Herb

Cooled decoction is taken twice a day to treat hypertension.

1

107

24.4 18.2 31.0 23.6 71 92 41 52 1 2 Flowers are eaten raw: 1) to treat sore throats; and 2) as carminative agent.

33.3 20.3 56 Verbena officinalis L. UOS180 Verbenaceae

Herb

Shamakay

Whole plant Flowers and leaves

1

79

26.8 17.2 45 1 Valeriana jatamansi Jones UOS179 Valerianaceae

Herb

Mushkebala

Roots

The powdered rhizome is mixed with desi ghee and is used as an antispasmodic and to treat epilepsy. Decoction of the fresh plant is taken orally twice a day as anti-malarial and coolant agent.

67

RF F Freq M Use Freq F Local uses Part used Local name (Pashto) Habit Botanical name Family name VSN

Table 1 (continued )

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

RF M

8

introduced herbs were gathered. During the survey differences were noted from area to area with respect to who were the main collectors of medicinal herbs. For example, in Upper Swat and Chitral the survey revealed that men were the principle collectors (71% and 59% respectively), but in Buner this task was mostly performed by the women (84%), which is also reflected by their extensive knowledge of medicinal plants. Children also played a part in the collection, more so in Upper Swat (68%) and Buner (62%) Districts, as compared to Chitral (36%). In all three districts, it was noted that village elders constituted a small percentage of medicinal herb gatherers. The study generally observed that during the winter months medicinal herb collection was suspended. In Upper Swat, most collection occurred during autumn and then spring, whereas in Buner spring was the predominant season, followed by autumn. In Chitral District however, the survey revealed that local communities conducted medicinal plant gathering mostly during the summer months. Medicinal herbs used and collected in the three Districts were, by far, essentially indigenous. On average, only 4% of herbs noted throughout the whole survey were introduced to the areas studied. Processing techniques comprised primarily of grinding and drying, however, fresh herbs were also used. A distinct difference was apparent between Buner and the other two districts surveyed in the use of fresh (unprocessed) and dried (processed) herbs. In Buner District it was found that fresh herbs were mostly used (60%), while in Upper Swat and Chitral dried herbs were chiefly used (82% and 76% respectively). In Upper Swat and Buner the majority of plant drying took place in the sun (85%), this also occurred in Chitral but to a slightly lesser extent (63%). Shade drying was practiced, but with only 15% of the dried herbs used in Upper Swat and Buner, and 37% in Chitral.

Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

4. Discussion The inhabitants of the area get a vast array of forest products from their surrounding biodiversity. Most of these are non-timber forest products, and especially medicinal plants. Similar observations on the use and dependence of local communities on resources from their surroundings were reported by others (Ahmad et al., 2014; Hamayun et al., 2006b, 2003b; Khan et al., 2011; Qureshi et al., 2009; Sher and Al-Yemeni, 2011; Sher, 2013; Sher et al., 2004; Shinwari and Khan, 2000; Tareen et al., 2010). Bano et al. (2014) also reported that human population growth, deforestation and over grazing problems in various parts of Swat District increase pressure on wild plant resources, and this results in an alarming decrease in availability of certain important medicinal plants species. Environmental consequences of deforestation, such a loss of plant and animal genetic resources, impact these societies on a social and economic plane through their potentially adverse effects. Ethnopharmaceutical information of the study area showed that 127 species of 59 families are locally used in traditional system of medicines. Similar results regarding plant resources were reported in other parts of Swat District (Ahmad et al., 2014; Hamayun et al., 2006b, 2003b; Sher and Al-Yemeni, 2011; Sher, 2002; Sher et al., 2004). However, their reported plant species and uses were different from our findings. The reported species diversity is similar to other studies in similar mountainous habitats (Ghorbani, 2005; Ghorbani et al., 2011; Mati and de Boer, 2011), but much lower than for tropical areas (de Boer et al., 2012; Subedi et al., 2013). Informants reported that natural regeneration of medicinal plants in the study area is under heavy pressure as a result of unauthorized collection, deforestation and overgrazing. The finding of the present study also agrees with that of Ahmad et al. (2014) who documented that unsustainable medicinal plant collection and habitat loss have put the conservation status of medicinal plants at risk in Swat District. Measures and strategies should be developed by government to save medicinal plants from overexploitation.

4.1. General knowledge The forest walks proved to be extremely beneficial to the study by indicating the breadth of knowledge of the men and women in the surveyed areas with respect to the flora and fauna within their immediate locality. In all areas surveyed, the number of medicinal plants on average known by women was less than that known by men. This could possibly be explained due to the fact that the status of women, and their social and economic development lag far behind that of men in these northern parts of Pakistan. Society and culture in these areas are highly conservative, and women are restricted in their movement for harvesting of plants. For example, a woman's status does not only depend on her legal rights but also on an array of traditional, tribal, customary and socio-economic rules. Numerous studies have shown women to be important custodians of medicinal plant knowledge (de Boer and Cotingting, 2014; Pfeiffer and Butz, 2005), but it has also been noted that women often use a more limited diversity of plant species as they collect these mostly around the homestead and from the village to the fields (Gollin, 2004; Kristensen and Balslev, 2003; Voeks, 2007). In general, both men and women on average had limited knowledge of the vast array of medicinal plants existing in their environment. However, in some areas, for example Amazai (Buner), the knowledge of the women was highly credible, in that they were able to give a comprehensive account about numerous medicinal herbs, with details of parts used and treatment regimes. All this information was conveyed without any difficulty. However,

9

the full potential of many of the herbs recorded was not understood, and therefore they were under-utilized. From a qualitative aspect, the social standing of women within the societies visited in the Survey bore an impact on who collected medicinal plants. Results from Buner District illustrate the noticeable differences in female status. This was visually observed whilst conducting the study, i.e. the majority of the women were farmers, and did more medicinal herb gathering than the men of that region. In Swat District however, only half of the women surveyed were farmers, and they played the most passive role with view to herb collection as compared with the other two districts. Occasionally local medicinal herbs were supplemented by those bought from the bazaar, hakim and others. This was not a particularly common practice, but it does demonstrate the confidence bestowed in medicinal herbs, and also highlights the need for local cultivation. It can be established from this study that both adults and children were treated using herbal medicine. Some herbs were specific to women (e.g. for gynecological/obstetric conditions), and certain herbs were only given to men (e.g. for male infertility). The elderly and children also received particular herbs suited to age specific ailments. 4.2. Women's knowledge Few women relied solely on herbal medicine, and the majority of households visited also sought the advice of doctors and pharmacists. The use of orthodox medicine was apparent even in the remotest of areas, as empty tablet packages were often in evidence. The standard arguments for using orthodox rather than herbal medicine were births, accidents, surgery, major illnesses, and even for trivial complaints e.g. headaches. This is similar to other studies (Agelet et al., 2000; Ahmad and Khaliq, 2002). They reported that the availability of herbs and their efficacy also influenced the decision regarding orthodox intervention. It was difficult to establish how effective traditional treatments of ailments really were. On observation, the older women of the community were found to be more knowledgeable than their younger counterparts. This is possibly due to the fact that the pharmaceutical industry's popularity has grown dramatically over the years to the extent that approximately 90% of the average household's health budget in Pakistan is spent on these drugs (Ahmad et al., 2014). It is apparent that if positive action is not taken in the near future towards rekindling the interest and faith in traditional medicine, then the knowledge may die out. 4.3. Local knowledge in perspective The most commonly reported species-uses are for species and uses that have often been studied extensively before. The use of C. dactylon as a haemostatic has been reported from India by Kumar et al. (2011). In China it has been reported to be ingested after serious loss of blood from wounds or at parturition (Perry and Metzger, 1980). A study of the haemostatic effect in a mouse model shows it to reduce clotting time and bleeding time (Leela and Ramesh, 2014). The use of A. sativa as an aphrodisiac is widely known and has been studied for erectile-dysfunction activity (Drewes et al., 2003). The use of C. australis against colic and for amenorrhea is also mentioned in traditional medicine in Battagram District in Khyber Pakhtunkhwa Province, Pakistan (Faizul et al., 2011), in the Allai Valley, Western Himalaya, Pakistan (Haq, 2012), and Madhya Pradesh, India (Shrivastava et al., 2011). A related species, Celtis tetrandra Roxb. is used in Assam to relieve postpartum pain (Buragohain, 2008). Pharmacological studies on the putative antispasmodic properties of Celtis species have not been conducted. The widespread use of D. stramonium roots to

Please cite this article as: Sher, H., et al., Indigenous knowledge of folk medicines among tribal minorities in Khyber Pakhtunkhwa, northwestern Pakistan. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.022i

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Q4 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 Q5

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treat fever and earache is not reported from elsewhere. D. stramonium is known to contain atropine and many poisonous alkaloids, but neither is used to treat fever (Perry and Metzger, 1980). D. stramonium has been reported as a pain killer, and as such could relieve earache (Chu, 1968). The traditional use is a decoction of the roots and the alkaloids might be extracted and eliminated in the process. The use of S. nigrum to treat fever is also reported by the Bantar people in Morang District in Nepal (Acharya and Pokhrel, 2006) and generally in Southeast Asia (Perry and Metzger, 1980). The only pharmacological studies that focus on relevant activity show that polysaccharides isolated from aqueous extracts of S. nigrum possess immunomodulatory ability (Li et al., 2008). S. laureola is used widely in northern Pakistan, but the specific use against dyspepsia is not widely reported and not supported by scientific studies (Ahmed et al., 2004; Hamayun et al., 2006a, 2003a; Saeed et al., 2004). The use of S. nervosa to ease child delivery is a unique and novel use of species in the genus, and no other ethnobotanical uses of S. nervosa are known. The traditional use of Z. jujuba fruit is reviewed by Mahajan et al. (2009). R. hastatus is used in Abbottabad District also in northern Pakistan to treat asthma, backache and rheumatism (Abbasi et al., 2010), and in Battagram District in northern Pakistan as a carminative, purgative, astringent, diuretic and to treat jaundice (Faizul et al., 2011). In the Shawar Valley in District Swat, R. hastatus has also been reported as a coolant (Hussain et al., 2006; Islam et al., 2006). Pharmacological studies corroborating this use are lacking. The traditional uses, chemical constituents and biological activities of Plantago species are excellently reviewed by Samuelsen (2000). Similar to the use of S. nervosa, the use of L. aphaca as a vulnerary appears to be a novel and unique use of this species. L. aphaca is otherwise known for its narcotic seeds and resolvent flowers (Chopra and Chopra, 1969). The consumption of F. palmata to aid digestion is also reported from the Kumaon Himalaya, Uttarakhand, India (Singh et al., 2014), but here too pharmacological studies corroborating this use are lacking.

5. Conclusions Medicinal plant knowledge is widespread among local communities in Khyber Pakhtunkhwa. The plant species that are most commonly used are often also used more widely in their areas of distribution. More often than not, the traditional uses can be corroborated with scientific studies into specific effects of the species and uses. Awareness of the market potential of medicinal herbs is critical in developing a sustainable local trade. Women as important collectors of medicinal plants can play a crucial role in this sustainable development and could potentially benefit from the economic empowerment that this trade could generate. To increase profitability it would be ideal if processing of medicinal plants to retail products could be done locally. Such processing would decrease marketing costs, as retail products require less space in storage and transportation than the dried herb itself. Educating people about the usage, collection, processing, storage, and marketing of medicinal herbs can teach them to begin to comprehend the potential advantage of such a venture. From an environmental perspective, awareness should be created amongst the community on the actual numbers of medicinal species growing in their area and how to maintain their populations through sustainable harvesting. Strong local involvement of villagers will be key to achieve optimal targets.

Acknowledgments The authors would like to thank all the people that participated in this study and shared their extensive knowledge on medicinal

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