Changing aspects of traditional healthcare system in western Ladakh, India

Harmony in nature: understanding the cultural and ecological aspects of plant use in Ladakh

BACKGROUND

Traditional knowledge (TK) in Ladakh encapsulates a repository of experimental wisdom cultivated over millennia. Despite this cultural wealth, dwindling interest among the younger generations in the region's age-old practices underscores the urgency to document TK. The current study investigates the diverse usage of plants in Surru, Wakha and Lower Indus valleys of Western Ladakh exploring the influence of socioeconomic and ecological factors.

METHODS

A stratified random sample approach was adopted to select 540 respondents for gathering information of useful plants through interviews and questionnaires. Participant observation, questionnaires, open-ended and semi-structured interviews were conducted for data collection. Free listing was done to create an extensive list of plants and their uses. Ethnobotanical metrics such as relative frequency of citation (RFC), relative importance index (RI), cultural value (CV) index and cultural importance (CI) index were computed to assess species applicability. Additionally, one-way analysis of variance (ANOVA) was utilized to discern significant differences in knowledge levels based on valleys, gender, education and religion using TK as a response variable.

RESULTS

Altogether, we recorded 246 plant species under various ethnobotanical uses from Western Ladakh. These include medicinal (126), fodder (124), wild ornamentals (86), food (81), fuel wood (54), dye (20), religious (31) and others (34). Novel plant reports include Berberis brandisiana Ahrendt and Dactylorhiza kafiriana Renz. The dominant plant family is Asteraceae with 35 species. Suru valley exhibits the highest number of cited plants followed by Wakha-chu and Lower Indus valleys (192, 168 and 152 species, respectively).

CONCLUSION

Disparities in plant use understanding are evident among different groups, prompting further investigation through intercultural comparisons. Plants such as Arnebia euchroma, Juniperus semiglobosa, and Artemisia species emerge with cultural importance. Gender, valley affiliation, religious background and the remoteness of a village all influence local plant knowledge. These variations are linked to socioeconomic disparities among communities.

Medicinal plants traditionally used in the health care practices by the indigenous communities of the Trans-Himalayan region of Ladakh, India

ETHNOPHARMACOLOGICAL RELEVANCE

Ladakh, "the land of high-rising passes," is a cold arid desert located in the India's northernmost part of the Trans-Himalayan region. Traditional knowledge of medicinal plants in this fragile ecosystem is an important part of the primary healthcare system, particularly in remote areas where modern medical facilities are not fully operational. There is a need to update the traditional information on medicinal plants from time to time to understand any addition of plants or uses to assist in developing new drugs through pharmacological and phytochemical studies.

AIM OF THE STUDY

The study was conducted to document the traditional knowledge and current therapeutic practices of the indigenous communities of Ladakh. Besides, the study strives to evaluate previous studies from Ladakh to identify plants that have not been previously reported for medicinal use.

MATERIAL AND METHODS

Ethnomedicinal information was collected from 350 local informants through open and semi-structured questionnaires and field surveys in 35 villages of 8 regions of Ladakh. The primary data were analyzed for use reports (UR) and the informant consensus factor (ICF). The reported diseases were classified according to the International Classification of Primary Care-2 (ICPC-2). New reported medicinal plants and unreported medicinal uses in this study were identified and compared to 36 prior studies conducted in Ladakh.

RESULTS

In the study, 176 medicinal plants belonging to 45 families and 131 genera were reported to treat 116 diseases of 16 (ICPC-2) groups with a total of 4841 use reports. Based on the highest use reports (UR), the most utilized species were Thymus linearis Benth. (134), followed by Aconitum heterophyllum Wall. (127) The highest informant consensus factor (ICF) was reported for Pregnancy, Childbearing, and Family Planning (ICF = 1) followed by respiratory (ICF = 0.91), and digestive (ICF = 0.90) disorders. Based on the comparative literature review, a total of 518 plant species (502 previously reported plus 16 newly cited) are being used in the Ladakh region. A total of 133 use reports for 16 newly cited plants using 30 diseases were recorded. The highest degree of overlapping of medicinal plants and uses for medicines was recorded in regions with comparable ethnicity, and shorter geographical distances. Based on the IUCN Red List, recorded medicinal plants include 7 critically endangered, 9 endangered, and 13 vulnerable species.

CONCLUSION

Ladakh's indigenous populations use a diverse range of medicinal plants to treat a variety of illnesses. The introduction of species and medicinal uses not previously cited in the primary health care system demonstrates that shared knowledge of traditional medicine among Ladakhi is still rich. The medicinal value of preferred medicinal plants has already been validated, but some medicinal plants lack scientific validation. We recommend further scientific studies on Aconitum violaceum Jacquem. ex Stapf,Anaphalis nepalensis var. monocephala (DC.) Hand.-Mazz., Allardia nivea Hook. f. & Thomson ex C.B. Clarke, Atriplex hortensis L., Eriophyton tibeticum (Vatke) Ryding, Iris lactea Pall. and Rheum webbianum Royle.

Ethnobotany, botany, phytochemistry and ethnopharmacology of the genus Thalictrum L. (Ranunculaceae): A review

ETHNOPHARMACOLOGICAL RELEVANCE

Thalictrum (Ranunculaceae) is known for its important alkaloids which have been reported to exhibit various pharmacological activities, viz. antitumor, antimicrobial, antitussive, antiamebic, hypotensive effects, HIV antiviral, etc. Throughout the world, the plant has been used as a tonic, purgative, stimulant, aperient and is utilized in various systems of medicine in the treatment of various ailments like snake bite, jaundice, rheumatism, stomachache, wounds, swellings, uterine tumors, paralysis, joints pain, nervous disorders, toothache, diarrhea, piles, fever, peptic ulcer, ophthalmic, headache, diuretic, dyspepsia, convalescence, etc. AIMS OF THIS REVIEW: To bring together all the information regarding the botany, phytochemistry, ethnobotany and ethnopharmacology of Thalictrum and identify the gaps in the existing studies so that full medicinal potential of the genus can be realized.

METHODS

Available literature on botany, geography, traditional uses, phytochemicals, and pharmacology was gathered by referring to library and electronic searches in PubMed, Science Direct, Google Scholar, relevant journals and books.

RESULTS

A variety of phytochemicals like alkaloids, essential oils, glycosides, phenols and terpenoids have been reported from Thalictrum species. Alkaloids are the most dominant diverse group with 178 different types. The crude extracts and isolates exhibit a gamut of pharmacological activities, namely anticancer, antimalarial, antioxidant, antipyretic, anti-tumor, ant-influenza virus, contraceptive and immunosuppressive. Northalrugosidine, an alkaloid from T. alpinum shows in vivo antileishmanial activity. So far, cytotoxic effects of only three Thalictrum species, viz. T. dasycarpum, T. foliolosum and T. simplex have been reported. Thl isolated from T. simplex is found to be 50% toxic (CC50%) at the concentration ranging from 53 to 95 μM.

CONCLUSIONS

Thalictrum has tremendous medicinal values used in many traditional systems of medicine. It has multiple chemical components and still there is scope to explore more. Multiple chemical constituents and its utilization signify its high demand in the drug markets or pharmaceutical companies. In depth phytochemical studies along with in vitro studies with respect to their active principles can help in tapping the full medicinal potential of the genus.

Chemical characterization by GC/MS analysis of Lactuca tatarica (L.) C.A.Mey. aerial parts and seeds

Lactuca tatarica is a wild species belonging to Asteraceae family omnipresent in Southern Caucasus region including Azerbaijan. Previous studies on the chemical content of some extracts obtained from its different organs have reported the presence of lactone sesquiterpenes, triterpenoids and flavonoids. For the first time, we investigated the volatile composition of L. tatarica aerial parts and seeds by GC/MS technique. The results showed the predominant presence of fatty acids, both saturated and unsaturated. Palmitic acid was prevalent in the aerial parts (up to 89.9%) while linoleic acid (up to 82.6%) was the most abundant component in the seeds. Other minor components were terpene and hydrocarbon derivatives. Some of the detected constituents in L. tatarica have already demonstrated antibacterial, antifungal, anti-inflammatory and antioxidant activity. Therefore, this species could be better studied for its biological properties and considered as a source of active ingredients useful in various fields including the pharmaceutical one.

Knowledge, Attitudes and Practices Regarding Traditional and Complimentary Medicine in Oman

Objectives

This study aimed to assess the knowledge, attitudes and practices regarding traditional medicine (TM) in Oman and examine the factors that necessitate its use.

Methods

This cross-sectional, questionnaire-based study was conducted among the general population from November 2019 and March 2020. All Omani nationals above the age of 18 were eligible to be enrolled. The questionnaire consisted of questions on the knowledge, attitudes and use regarding traditional medicine in Oman.

Results

A total of 598 responses to the questionnaire were received (response rate: 85.4%), of which 552 were deemed complete. Most responses were received from males (62.5%) and the sample had a mean age of 33.6 ± 7.7 years. A majority of the respondents (90%) were aware of the different types of TM in Oman; a high percentage (81.5%) felt that it was effective. Most (67.8%) had tried at least one method of TM use. Individuals who were older had tried TM compared to those who had not (34.5 ± 7.8 years versus 31.8 ± 7.2 years; P <0.001); in addition, more males than females (72.2% versus 27.8%; P <0.001) and those with full-time employment than those without had tried TM (84.2% versus 14.2%; P <0.001). Herbal medications (65.8%) and traditional massage (60.4%) were the most common forms of TM practice. Among females, herbal medications (69.2%) and massage (63.5%) are most often used; among males, cupping (65.2%) followed by herbal medications (64.4%) and massage (59.3%) were used more often. Notably, back pain (74.3%) was the most common condition for which TM was reportedly used, with only a small percentage (8.3%) reporting any concomitant side-effects.

Conclusion

There is widespread use of TM among Oman's urban population. An improved understanding of their benefits will facilitate their incorporation into modern health care services.

Medicinal plants used by rural communities in the arid zone of Viesca and Parras Coahuila in northeast Mexico

This study is the first record of medicinal plants in the southwest of the Coahuila state, an arid zone where extreme dry conditions prevail. One hundred twenty-two residents (in sixteen communities) were interviewed. The residents were questioned with a questionnaire-guided ethnomedical survey protocol about the various plants used. Seventy-seven species of medicinal plants belonging to 36 botanical families were cited. The highest use-value (UV) was calculated for Lippia graveolens Kunth (0.30); Aloe vera (L.) Burm.f. (0.20); Eucalyptus abdita Brooker & Hopper, Chamaemelum nobile (L.) All. (0.16); Mentha spicata L. (0.15) and Salvia officinalis L. (0.10). Informant consensus factor (ICF) about usages of medicinal plants ranges from 0.41 to 0.80; the highest level of agreement was determined between the informants and Respiratory System Diseases (0.80). The highest fidelity level (FL) values (100%) were identified in Flourensia cernua DC., Artisia ludoviciana Nutt., and Parthenium incanum Kunth to Gastro-intestinal System Diseases; Eucalyptus abdita Brooker & Hopper, Bougainvillea berberidifolia Heimerl, and Lippia graveolens Kunth to Respiratory System Diseases (RSD) and Cyclolepis genistoides D.Don and Ephedra antisyphilitica Berland. ex C.A.Mey. to Obstetrics, Gynecology and Urinary tract Diseases. These last two medicinal plant species ("palo azul" and "pitoreal") used by the rural communities in Viesca in the treatment of urinary tract infections and kidney stones have not been reported previously. These findings can provide new research directions for further phytochemical studies. The present study revealed that the residents are rich in ethno-medicinal knowledge and actively use medicinal plants to treat various diseases. New phytochemical and pharmacological research are needed to confirm the therapeutic potential and safety of the identified plants.

Feature tuning improves MAXENT predictions of the potential distribution of Pedicularis longiflora Rudolph and its variant

Pedicularis longiflora Rudolph and its variant (P. longiflora var. tubiformis (Klotzsch) Tsoong) are alpine plants and traditional Chinese medicines with important medicinal value, and future climate changes may have an adverse impact on their geographic distribution. The maximum entropy (MAXENT) model has the outstanding ability to predict the potential distribution region of species under climate change. Therefore, given the importance of the parameter settings of feature classes (FCs) and the regularization multiplier (RM) of the MAXENT model and the importance of add indicators to evaluate model performance, we used ENMeval to improve the MAXENT niche model and conducted an in-depth study on the potential distributions of these two alpine medicinal plants. We adjusted the parameters of FC and RM in the MAXENT model, evaluated the adjusted MAXENT model using six indicators, determined the most important ecogeographical factors (EGFs) that affect the potential distributions of these plants, and compared their current potential distributions between the adjusted model and the default model. The adjusted model performed better; thus, we used the improved MAXENT model to predict their future potential distributions. The model predicted that P. longiflora Rudolph and its variant (P. longiflora var. tubiformis (Klotzsch) Tsoong) would move northward and showed a decrease in extent under future climate scenarios. This result is important to predict their potential distribution regions under changing climate scenarios to develop effective long-term resource conservation and management plans for these species.

A Cross-Cultural Analysis of Plant Resources among Five Ethnic Groups in the Western Himalayan Region of Jammu and Kashmir

Simple Summary

For generations, local ethnic communities have amassed a vast body of traditional ecological knowledge (TEK) on the use of plant resources. Ethnobiologists have recently focused on cross-cultural studies in order to record and measure the processes guiding the evolution of TEK within a specific society; both to preserve it and use it sustainably in the future. The current study documents the TEK of plant resources from five ethnic communities of the Jammu and Kashmir (J&K) region, Western Himalayas. Through semi-structured interviews and group discussions, we recorded a total of 127 plant species used by local ethnic groups for various provisioning services (i.e., medicine, food, fodder, fuelwood, herbal tea) and/or with spiritual significance. Across the ethnic groups, Gujjar reported the highest number of plants (25% species), followed by Pahari (24% species), and the lowest number of plants were reported by Dogra (12% species). Looking at plant uses among different cultural groups, we discovered that, especially, some ritual practices were associated with specific plants. We found a relatively high overlap in the use of specific plants among the ethnic groups, namely Gujjar, Bakarwal, and Pahari. Certain species were found to be common in all cultures due to their food value. The current study is a collaborative effort that includes not only documenting, but also cross-cultural comparisons of the documented species, in order to better understand the diverse traditional plant usage systems. This will not only increase regional understanding of cross-cultural ethnobotany, but it will also open opportunities for local people to be rewarded for promoting and celebrating their expertise and participating in future development activities.

Abstract

Plant resources have always been valuable in human life, and many plant species are used in medicine, food, and ritual, and resource utilization is closely related to cultural diversity. Our study was conducted from June 2019 to April 2021, during which we aimed to document the local knowledge of plant resources of five ethnic groups, i.e., the Gujjar, Bakarwal, Kashmiri, Pahari, and Dogra communities of the Jammu and Kashmir (J&K) region, Western Himalayas. Through semi-structured interviews (N = 342) and group discussions (N = 38), we collected data on the ethnobotanical uses of plant resources. The data was subjected to hierarchical cluster analysis and ordination techniques (Principal Component Analysis) via, R software of version 4.0.0. Traditional uses were classified into three groups, i.e., single-, double-, and multi-use groups. The study recorded a total of 127 plant species, belonging to 113 genera and distributed among 64 botanical families. The dominant plant families were the Asteraceae, with 8% of all species, followed by Lamiaceae (6%), Polygonaceae (5%) and Ranunculaceae (4%). The recorded plant taxa were frequently used for medicine (51.4% responses), followed by food (14.9%), and fodder (9.5%). Principal component analysis (PCA) separated three groups of provisioning services depending on plant consumption preference levels. Comparative analysis showed remarkable similarities in plant uses (food, medicinal) among the Gujjar and Bakarwal ethnic groups, as both groups share a common culture. Some plants like Azadirachta indica, Brassica campestris, Ulmus wallichiana, Amaranthus blitum, and Celtis australis were also used for magico-religious purposes. We also recorded some medicinal uses that are new to the ethnobotanical literature of the J&K Himalayas, such as for Betula utilis, Sambucus wightiana, and Dolomiaea macrocephala, in our case for example local medicinal recipe, which is derived from Dolomiaea macrocephala, often known as Nashasta, used to treat weakness, back pain, and joint pain. Similarly, we also recorded new food uses for Eremurus himalaicus. Moreover, we also observed some plants for instance, Fragaria nubicola, Betula utilis and Juniperus communis have spiritual significance (i.e., amulets and scrolls) for this part of the Himalayan region. The present study provides a useful tool for resource management and can help in developing scientifically informed strategies for the conservation of plant resources.

Promastigotes of Leishmania donovani exhibited sensitivity towards the high altitudinal plant Cicer microphyllum

In this study, we explored Cicer microphyllum (CM), a Trans-Himalayan plant for its chemical components by GC-MS, phytochemical quantitation, and anti-leishmanial efficacy against sensitive strain (SS) and resistant strain (RS) promastigotes of L. donovani in vitro. The hydroethanolic extract of aerial parts of CM was screened for the presence of chemical compounds and phytochemical estimation. The antileishmanial activity of CM was assessed against the promastigotes of L. donovani. The cell volume and cell viability were analyzed by flow cytometry. The generation of reactive oxygen species (ROS) and lipid bodies was determined after treatment with reference and test drug. The extract of CM is complemented with major plant secondary metabolites and the quantitative assessment for phytoconstituents showed the highest concentration of phenols followed by flavonoids and terpenoids. Different biologically active chemical compounds were identified by the GC-MS analysis. The 50% inhibitory concentrations against L. donovani sensitive strain were 14.40 μg/ml and 23.03 μg/ml whereas for resistant promastigotes these were 49.84 μg/ml and 26.77 μg/ml after SAG (sodium stibogluconate) and CM exposure, respectively. CM treatment reduced cell viability induced by loss in plasma membrane integrity. Drug treatment resulted in higher ROS generation and production of lipid bodies. GC-MS screening of the extract revealed the richness of active chemical components in CM. The presence of diverse phytochemicals, no cytotoxicity to human macrophages, and the antileishmanial action of CM depicted its potential as an alternative future drug.

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First report of in vitro leishmanial activity of Cicer microphyllum (CM) against SAG-resistant and SAG-sensitive strain.

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Chemical characterization of CM by GC-MS revealed biologically active components.

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CM augmented ROS production and lipid bodiesʼ formation in Leishmania parasites.

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Parasitic cells exhibited loss of membrane integrity upon drug treatment.

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No significant toxicity on THP-1 cell line was observed.

Ethno-medicinal uses of vertebrates in the Chitwan-Annapurna Landscape, central Nepal

Traditional knowledge on the use of animal products to maintain human health is important since time immemorial. Although a few studies reported food and medicinal values of different animals, a comprehensive ethno-medicinal study of vertebrates in Nepal is still lacking. Thus, present study is aimed at documenting the ethno-medicinal knowledge related to vertebrate fauna among different ethnic communities in the Chitwan-Annapurna Landscape, central Nepal. Data was collected by using semi-structured questionnaires and analyzed by using Use Value (UV), Informant Consensus Factor (ICF) and Fidelity level (FL). Results showed a total of 58 (53 wild and 5 domestic) species of vertebrate animals. They were used to treat 62 types human ailments. Four animals were also used for veterinary diseases and agriculture benefits. The most widely used species was Felis chaus (UV = 0.25) with 3 use-reports by 10 informants. Cardiovascular and dental problems had the highest ICF value (0.974) with cardiovascular problems having 351 use-reports for 10 animal species and dental problems having 77 use-reports for 3 animal species. The least ICF was found in ophthalmological problems (ICF = 0.833, use reports = 7 for 2 species). We concluded that the different animals were an important part of traditional medicine for the local people living in the Chitwan-Annapurna Landscape. However, the majority of animals and most likely to be threatened due to their uses. The present documented ethnozoological knowledge can be used in conservation and management of vertebrates so that they could be protected for future generations.

The first bioactivity studies of Acantholimon lycopodioides from high altitude Karakoram-Himalayan desert

Couple of ethnopharmacological surveys in the Indian Ladakh and Pakistani Shigar valleys has reported the medicinal use of Acantholimon lycopodioides against cardiac and gastric disorders that however, remains without scientific rationale or experimental validations. Here, we assess the in vitro bio/therapeutic activities of A. lycopodioides extracts as well as chloroform, ethyl acetate, n-butanol and aqueous fractions. The in vitro β-carotene-linoleic acid bleaching and DPPH radical scavenging methods demonstrated a very high anti-oxidative property of chloroform and ethyl acetate fractions compared to others. Cell viability assay (MTT) on human cervical (HeLa), breast (MDA-MB321) and liver (HepG2) cancer cells revealed their differential cytotoxicity, except the chloroform fraction. Of these, the precipitate exerted highest cytotoxicity on HepG2 cells followed by aqueous fraction on MDA-MB321 cells. Notably, the non-cytotoxicity of chloroform fraction coincided with its highest anti-oxidative activity. Further, the chloroform fraction showed marked hepatoprotection (up to 84%) against 3'7'dichlorofluorescin triggered free radicals induced oxidative damage. Also, the hepatoprotective chloroform fraction mildly activated CYP3A4 in HepG2 cells (dual-luciferase assay). Moreover, the A. lycopodioides extracts and fractions showed differential anti-bacterial and anti-fungal activities. Of these, while S. aureus was more sensitive to the water-insoluble extract, ethyl acetate fraction showed moderate activity against E. coli and C. albicans. On the other hand, the chloroform fraction showed promising activity against S. Aureus, C. albicans, P. vulgaris and E. faecalis. In conclusion, our data for the first time, demonstrated promising anti-oxidative, hepatoprotective, anti-cancer, anti-microbial and CYP3A4 activating salutations of A. lycopodioides. This warrants further studies towards isolation and identification of its therapeutically active principles.

The genus Tragopogon (Asteraceae): A review of its traditional uses, phytochemistry, and pharmacological properties

ETHNOPHARMACOLOGICAL RELEVANCE

Species of Tragopogon are used in traditional medicine, and consumed as vegetables across the world. In terms of the medicinal uses of Tragopogon, different species have found use in traditional medicine, including uses for wound-healing, treatment of gastrointestinal and hepatic complaints, cancer, kidney and liver dysfunction, inflamed skin and certain cutaneous diseases, as well as constipation, fatigue and anoxia.

AIM OF THE STUDY

The aim of this review is to highlight and critically summarize those species of the genus that have been studied as a source of interesting lead compounds, and their traditional uses and bioactivities.

MATERIALS AND METHODS

A comprehensive and systematic review of literature on traditional uses, phytochemicals and pharmacological properties of the genus Tragopogon was carried out. Information was retrieved from secondary databases such as Scopus, Chemical Abstracts Services (Scifinder), Pubmed, Google Scholar and ScienceDirect, in addition to primary sources including books, PhD and MSc dissertations, and official websites. Species names were validated using "The Plant List" (www.theplantlist.org).

RESULTS

The taxa of the genus Tragopogon are known for their local and traditional uses as medicine for treatment of various diseases, and have been consumed as vegetables and snacks for generations in Eurasia, the Mediterranean, Caucasus, Europe and North America. From the approximately 110 species of Tragopogon, only twelve species have been scientifically evaluated for their bioactivity and/or phytochemical composition. Tragopogon species are a rich source of phytochemical constituents and among those that have been identified are 19 flavonoids, 35 terpenoids, seven bibenzyl derivatives, five benzylphtalides, six stilbenes, nine dihydroisocoumarin derivatives, nine phenylmethane derivatives, three hydroxyphenylacetic acid derivatives, four phenylpropane derivatives, four esters of phenylpropanoic acids, a coumarin derivative, and a spermine derivative. Various extracts of the taxa, in addition to the isolated compounds, demonstrated pharmacological properties such as antitumor, antimicrobial, anti-inflammatory and enzyme inhibitory activities, in addition to hepatoprotective, antihyperlipidaemic and wound-healing properties.

CONCLUSION

This review highlights the traditional uses, phytochemistry and pharmacological properties of the few studied taxa of the genus Tragopogon. Some of the reviewed papers were not of an appropriate methodological standard. For instance, phytochemical profiles were not determined, and the fundamental requirements of the pharmacological properties were not defined such as including appropriate positive and negative controls, and calculating the MIC values. Furthermore, these studies did not provide an in depth evaluation of bioactivity of the extracts and the isolated compounds or in vivo experiments which could indicate therapeutic relevance. From a phytopharmacological point of view, this review recommends more high quality evidence-based research on Tragopogon species for further development of plant-derived remedies and compounds.

Bioactivity of the Geranium Genus: A Comprehensive Review

BACKGROUND

Plants from the Geranium genus, which comprises about 400 species, have been used since ancient times in the practice of traditional medicines throughout the world. Therefore, herbal preparations based on Geranium species have found wide usage for the treatment of a variety of ailments. The aim of this work is to present a review, as comprehensive as possible, of the studies concerning different biological activities of Geranium species.

METHODS

Relevant data were obtained through systematic computer searches from major reputed scientific databases, particularly Web of Science and Scopus. Occasionally, information issued in primary sources not covered by these databases was also included provided published as peer-reviewed literature. This review covers the literature disclosed till the end of 2018.

RESULTS

Accompanying the increasing interest in herbal medicines in general, the evaluation of the biological properties of medicinal plants from the Geranium genus has been addressed thoroughly, mostly over the last two decades. Geranium species are endowed with a number of different biological activities. Herein, we present a survey of the results of the studies concerning these different biological activities.

CONCLUSION

Most studies found in the literature effectively contribute to scientifically validate the beneficial properties of Geranium plants claimed by traditional medicines and medical herbalism and demonstrate that many of them possess evident therapeutic properties.

Ethnopharmacology, phytochemistry and biological activity of Erodium species: A review

Erodium spp. is a genus that can be found in all continents that has been traditionally used in folk medicine to treat many diseases such as hemorrhage, dermatological disorders, indigestion, and inflammatory diseases. Moreover, Erodium leaves have been used for the preparation of salads, omelets, sandwiches, sauces and soups, among other food products. The objective of this review was to show the recent and relevant studies about extraction of bioactive compounds, the phytochemical characterization, the potential biological activities and toxicological evidence reported in both in vitro and in vivo studies from Erodium spp. In addition, the use of Erodium spp. as natural compounds against the development of diseases were also showed. This review highlights the traditional use of Erodium species in several countries as a therapeutic agent to treat several diseases (such as constipation, dermatological disorders, diabetes, indigestion, urinary inflammations, and as carminative agent), the factors influencing the extraction of bioactive compounds (mainly species and solvent composition on phenolic compounds) and phytochemical profile (presence of essential oils and alkaloids), the scientific evidence about its anti-inflammatory, antimicrobial (against both spoilage and pathogenic microorganisms), antiviral and other health-related activities (anti-protozoal and anti-viral activity) as well as the toxicological evidence. Erodium spp. is a relevant source of compounds with antioxidant, antimicrobial, and biological activity, which support its potential exploration in pharmacological and food area. Major efforts are necessary to advance the knowledge about Erodium genus regarding the relation between traditional use and scientific evidence, optimization of extraction conditions, the influence on biological mechanisms at animal and clinical levels, and bioaccessibility and bioavailability of bioactive compounds.

Pedicularis L. Genus: Systematics, Botany, Phytochemistry, Chemotaxonomy, Ethnopharmacology, and Other

In this review, the relevance of the plant species belonging to the Pedicularis L. genus has been considered from different points of view. Particular emphasis was given to phytochemistry and ethnopharmacology, since several classes of natural compounds have been reported within this genus and many of its species are well known to be employed in the traditional medicines of many Asian countries. Some important conclusions on the chemotaxonomic and chemosystematic aspects of the genus have also been provided for the first time. Actually, this work represents the first total comprehensive review on this genus.

Medicinal plants brought by Indian indentured immigrants: A comparative review of ethnopharmacological uses between Mauritius and India

ETHNOPHARMACOLOGICAL RELEVANCE

Mauritius is famous for its floricultural diversity and traditions practiced across the island by various ethnic groups. During the British rule in the 1835s, Indian indentured labourers migrated to Mauritius and played a very important role in shaping the Mauritian culture. They brought along their high heritage of traditional knowledge of certain medicinal herbs and spices. Nonetheless, there has been no comparative study to investigate whether these past traditional knowledge are still preserved in Mauritius and India.

AIM OF THE STUDY

To document and compare the traditional uses of medicinal herbs and spices brought by Indian indentured labourers with their current uses in Mauritius and India, and to review pharmacological studies of such plants.

MATERIALS AND METHODS

Locally published textbooks, research dissertations, and relevant records from the 'Mauritiana' section of the University of Mauritius library were scrutinised for possible early records of such herbs and spices brought by Indian indentured immigrants. Field trips and site visits to Mauritius Herbarium and The National Folk Museum were conducted to gather data on their traditional uses as practiced by the Indian indentured immigrants. A literature search was performed to gather the current ethnomedicinal uses of these plants in Mauritius and India using key databases such as ScienceDirect and PubMed, as well as thesis from local university website. Pharmacological studies on these plants were also reviewed in an attempt to compare the ethnomedicinal uses against reported ailments.

RESULTS

Indian labourers brought 18 medicinal plants for medicinal purposes as documented at the folk museum of Indian Immigration. Piper betle L., Azadirachta indica A. Juss., and Curcuma longa L. were common plants used by Indian indentured immigrants against a wide range of ailments. Data obtained from recent ethnomedicinal surveys revealed that A. indica and C. longa were the most traditionally used plants in India, while in Mauritius, C. longa was the most popular plant followed by Allium sativum L. and Ocimum tenuiflorum L. It was also found that all these plants are currently being used against a wide range of diseases in both countries. In addition, several studies have highlighted the pharmacological properties such as analgesic, anti-inflammatory, anti-microbial, anti-pyretic, and anti-diabetic for some plants.

CONCLUSION

This investigation can be considered as a first attempt to document and compare traditional knowledge of medicinal plants brought by Indian immigrants. We observed that some of these knowledge are preserved and still practiced in Mauritius. It is anticipated that this study will revive the interest in safeguarding and promoting the ancestral knowledge on the uses of such plants.

Shilajit (Mumie): Current Status of Biochemical, Therapeutic and Clinical Advances

Methods:

Scientific literature and ethnopharmacological information were compiled from the published peer-reviewed articles, unpublished materials, thesis, books, patent databases, clinical trial registries and from the websites of research councils of traditional medicine. The scientific databases, thesis repositories and books databases were searched with keywords Shilajit, mumie, mumijo, salajeet, asphaltum, fulvic acid, dibenzo-alpha-pyrones etc.

Results:

Scientifically validated research and ancient texts suggest multifaceted benefits of Shilajit. It is endowed with anti-stress, memory and energy enhancing, antioxidant, anti-inflammatory, antidiabetic, spermatogenic, neuroprotective, antiulcer and wound healing activities. These pharmacological effects are mainly attributed to the presence of humic acid, fulvic acid, dibenzo-&#945;-pyrones, dibenzo- &#945;-pyrones chromoproteins and trace elements.

Conclusion:

This review summarizes the traditional importance of Shilajit for the treatment and prevention of several acute and chronic diseases and health ailments. Despite numerous health claims, there are still major gaps in our understanding of its mechanism of action, variability in efficacy and toxicity profile. Therefore, a coordinated interdisciplinary approach is needed to establish the underlying mechanisms of action, comprehensive toxicological profile, pharmacokinetics parameters and effects on different organ systems. Regulatory and governmental impetus to basic and clinical research, safety testing and formulations quality control is warranted.

Regional trade of medicinal plants has facilitated the retention of traditional knowledge: case study in Gilgit-Baltistan Pakistan

BACKGROUND

The ethnic groups in Gilgit-Baltistan have been utilizing local resources in their centuries-old traditional healing system. Most tribes within these ethnic groups still rely on traditional healing systems. We aim to understand the current status, uses, and abundance of medicinal plants, associated traditional knowledge, and trade.

MATERIALS AND METHODS

The study incorporated over 300 local community members (70% men and 30% women) in focused group discussions, semi-structured interviews, and homework assignments for 8th to 12th grade students to document traditional knowledge (TK) in six districts in Northeast Pakistan. We calculated various indices such as informant consensus factor, use value, relative frequency of citation, and CoKriging. These indices, along with repetitively used medicinal plants, were used to analyze differences in studied locations.

RESULTS

Most of the community members still rely on traditional medication in the study areas. However, we found the highest number of medicinal plants used in Skardu and Gilgit compared to other districts and these two districts also represent trade centers and a highly populated area regarding medicinal plants. Results indicate connection amongst the surveyed villages signifying mixing of knowledge from different sources, with certain areas more influenced by traditional Chinese medicine and others more by Ayurveda and Unani.

CONCLUSION

TK is mostly retained with elder community members; however, those directly linked with market value chain retain rich knowledge on traditional use of the medicinal plants from the region. Major trade centers in the region also coincide with a high density of medicinal plant occurrence, knowledge, and higher utilization. Therefore, with the increasing trade in medicinal plant in the region, there is potential for rejuvenation of this knowledge and of plant use in the region.

Ethnopharmacological Approaches for Therapy of Jaundice: Part I

Jaundice is a very common symptom especially in the developing countries. It is associated with several hepatic diseases which are still major causes of death. There are many different approaches to jaundice treatment and the growing number of ethnomedicinal studies shows the plant pharmacology as very promising direction. Many medicinal plants are used for the treatment of jaundice, however a comprehensive review on this subject has not been published. The use of medicinal plants in drug discovery is highly emphasized (based on their traditional and safe uses in different folk medicine systems from ancient times). Many sophisticated analytical techniques are emerging in the pharmaceutical field to validate and discover new biologically active chemical entities derived from plants. Here, we aim to classify and categorize medicinal plants relevant for the treatment of jaundice according to their origin, geographical location, and usage. Our search included various databases like Pubmed, ScienceDirect, Google Scholar. Keywords and phrases used for these searches included: "jaundice," "hyperbilirubinemia," "serum glutamate," "bilirubin," "Ayurveda." The first part of the review focuses on the variety of medicinal plant used for the treatment of jaundice (a total of 207 medicinal plants). In the second part, possible mechanisms of action of biologically active secondary metabolites of plants from five families for jaundice treatment are discussed.

Extracts and compounds active on TRP ion channels from Waldheimia glabra, a ritual medicinal plant from Himalaya

BACKGROUND

Waldheimia glabra (Decne.) Regel is a wild plant from the Himalayan Mountains, commonly known as Smooth Ground Daisy. This plant is traditionally used by local populations in religious rituals (incense) or in traditional herbal medicine to treat skin diseases, headache, joint pain and fever. In literature few data are available on the investigation of this aromatic plant.

PURPOSE

The present work aims at deepening knowledge about the chemical composition of W. glabra extracts and incense, as well as its activity on TRP ion channels.

METHODS

Extracts and incense of W. glabra were analyzed by using HS-SPME GC/MS, GC/MS and NMR analysis. Tests on the activity of W. glabra extracts and isolated compounds (+)-ludartin 1 and B-ring-homo-tonghaosu 2 on TRP channels were also performed.

RESULTS

Some extracts and pure compounds from W. glabra showed an interesting activity in terms of efficacy and potency on rat TRPA1, an ion channel involved in several sensory mechanisms, including pungency, environmental irritation and pain perception. Activity is discussed and compared with that of other known TRPA1 natural agonists with different chemical structures. All compounds showed only a negligible inhibition activity on rat TRPM8 ion channel.

CONCLUSIONS

Our findings demonstrate that W. glabra is involved in the receptor activation mechanism and therefore represents a new natural product potentially useful in pharmaceutical and agrifood research.

Ethnopharmacological Approaches for Therapy of Jaundice: Part I

Jaundice is a very common symptom especially in the developing countries. It is associated with several hepatic diseases which are still major causes of death. There are many different approaches to jaundice treatment and the growing number of ethnomedicinal studies shows the plant pharmacology as very promising direction. Many medicinal plants are used for the treatment of jaundice, however a comprehensive review on this subject has not been published. The use of medicinal plants in drug discovery is highly emphasized (based on their traditional and safe uses in different folk medicine systems from ancient times). Many sophisticated analytical techniques are emerging in the pharmaceutical field to validate and discover new biologically active chemical entities derived from plants. Here, we aim to classify and categorize medicinal plants relevant for the treatment of jaundice according to their origin, geographical location, and usage. Our search included various databases like Pubmed, ScienceDirect, Google Scholar. Keywords and phrases used for these searches included: “jaundice,” “hyperbilirubinemia,” “serum glutamate,” “bilirubin,” “Ayurveda.” The first part of the review focuses on the variety of medicinal plant used for the treatment of jaundice (a total of 207 medicinal plants). In the second part, possible mechanisms of action of biologically active secondary metabolites of plants from five families for jaundice treatment are discussed.

Ethnomedicinal uses of plants for the treatment of malaria in Soon Valley, Khushab, Pakistan

ETHNOPHARMACOLOGICAL RELEVANCE

To best of our knowledge this is the first quantitative ethno-medicinal study with the aim of documenting the indigenous knowledge and practices of using plants for malarial therapy in Soon Valley, Khushab, Pakistan. In this Valley, malaria is among the major public health problems but, until now, the population still mostly relies on herbal medicine for treatment.

MATERIALS AND METHODS

Ethno-medicinal data were documented from 63 informants by using semi-structured questionnaires and interviewing the informants about their knowledge of plants regarding malaria and related symptoms. Documented data were evaluated using the quantitative ethno-botanical indices of frequency citation (FC), relative frequency of citation (RFC), percentage of respondents having knowledge (PRK) and Jaccard index (JI).

RESULTS

A total of 70 plant species belonging to 62 genera and 34 families were recorded as anti-malarial in the study area. Solanaceae was found to be the most cited family with 7 species, followed by Fabaceae, Rutaceae and Lamiaceae with 5 species each. Ocimum americanum and Solanum incanum were the species with the highest relative frequency of citation (RFC =0.25 each) and percentage of respondents having knowledge (PRK =25.4% each), followed by Grewia tenax (RFC =0.23, PRK =23.8%), which indicates that these plants are the best species with anti-malarial properties. The most highly cited life form was found to be herbs (56%). The dominant plant part used in preparations were leaves (49%). The main mode of utilization was decoction (47%) followed by infusion (29%). In comparison, maximum similarity index is found in our study with JI (16.83) followed by (13.13). Similarity percentage of plants uses ranges from 0.81 to 16.83 while dissimilarity percentage varies from 0% to 17.65%.

CONCLUSIONS

To the best of our knowledge seven plant species, viz. Withania coagulans, Fagonia cretica, Carthamus oxyacantha, Ehretia obtusifolia, Helianthus annuus, Olea ferruginea and Vitex trifolia, are reported from this region for the first time for the treatment of malaria. This first ethno-medicinal study highlights potential sources for the development of new antimalarial drugs from indigenous knowledge of medicinal plants found in the Soon Valley, Pakistan. Such investigations could be a subject for in vitro and in vivo anti-plasmodial screening to develop new plant-based antimalarial drugs and can also be evaluated for other biological activities and novel drug discoveries.

Screening of the chemical composition and bioactivity of Waldheimia glabra (Decne.) Regel essential oil

BACKGROUND

This research aimed at improving knowledge as to the chemical composition and the antibacterial and anti-cancer activities of the essential oil of Waldheimia glabra, a wild plant from the Himalayan Mountains.

RESULTS

The results obtained by GC-MS showed that spathulenol, 9-tetradecenol, thujopsene, α-thujone, santolina alcohol and terpinen-4-ol were the main constituents of Waldheimia glabra essential oil. These results were confirmed by HS-SPME GC-MS analysis that also reported high amounts of artemisia alcohol and camphor. Disc diffusion assay suggested a mild antibacterial activity against both Escherichia coli and Staphylococcus aureus. Finally, a dose-response correlation was observed between Waldhemia glabra essential oil concentration and viability of human breast adenocarcinoma cells MDA-MB-231 and MCF-7.

CONCLUSIONS

Together with the GC-MS method, HS-SPME GC-MS proved to be a reliable technique to characterise the chemical composition of essential oil obtained from aromatic plants. Further studies will focus on W. glabra phytochemicals and their biological activity, in order to support traditional uses of the plant. © 2015 Society of Chemical Industry.

Use of traditional medicine in middle-income countries: a WHO-SAGE study

It is frequently stated in the scientific literature, official reports and the press that 80% of Asian and African populations use traditional medicine (TM) to meet their healthcare needs; however, this statistic was first reported in 1983. This study aimed to update knowledge of the prevalence of TM use and the characteristics of those who access it, to inform health policy-makers as countries seek to fulfil the WHO TM strategy 2014–23 and harness TM for population health. Prevalence of reported use of TM was studied in 35 334 participants of the WHO-SAGE, surveyed 2007–10. TM users were compared with users of modern healthcare in univariate and multivariate analyses. Characteristics examined included age, sex, geography (urban/rural), income quintile, education, self-reported health and presence of specific chronic conditions. This study found TM use was highest in India, 11.7% of people reported that their most frequent source of care during the previous 3 years was TM; 19.0% reported TM use in the previous 12 months. In contrast <3% reported TM as their most frequent source of care in China, Ghana, Mexico, Russia and South Africa; and <2% reported using TM in the previous year in Ghana, Mexico, Russia and South Africa. In univariate analyses, poorer, less educated and rural participants were more likely to be TM-users. In the China multivariate analysis, rurality, poor self-reported health and presence of arthritis were associated with TM use; whereas diagnosed diabetes, hypertension and cataracts were less prevalent in TM users. In Ghana and India, lower income, depression and hypertension were associated with TM use. In conclusion, TM use is less frequent than commonly reported. It may be unnecessary, and perhaps futile, to seek to employ TM for population health needs when populations are increasingly using modern medicine.

Medicinal plants of the family Caryophyllaceae: a review of ethno-medicinal uses and pharmacological properties

Several species of the family Caryophyllaceae are widely used by many ethnic communities as traditional medicine throughout the world. The highest number of plants of the family are used in Chinese traditional medicine. The ethnopharmacologial studies of this family indicate that plants of the family possess anticancer, antibacterial, antifungal, antiviral, antioxidant, and anti-inflammatory properties. Other miscellaneous properties reported are ribosome inactivation properties, inhibition of prostatic enlargement in rats, and inhibition of intestinal enzyme carboxyelasterase in rats, cerebro-protective activity, and antiobesity in rats. Few reviews have been published yet, providing information regarding medicinal plants of the family and their biomedical properties. All published reviews have focused either on a particular taxa or a few species. The present review is focused on the traditional medicinal uses of the plants of the family Caryophyllaceae along with phytochemical and pharmacological studies of the family. A study of the literature revealed significant traditional medicinal importance of the family. Major chemical constituents of Caryophyllceae are saponins, Phytoecdysteroids, benzenoids, phenyl propanoids, and nitrogen containing compounds. The most important property of plants of the family is anticancer activity and is shown by the large number of plant species studied. This review of traditional medicinal and pharmacological uses of plants of the family, provide a ground for future research in the family.

Ethno-medicinal study of plants used for treatment of human ailments, with residents of the surrounding region of forest fragments of Paraná, Brazil

ETHNOPHARMACOLOGICAL RELEVANCE

This study aims to document the traditional knowledge on the use of medicinal plants in the neighborhood of the protected area "Parque Estadual da Cabeça do Cachorro", a fragment of seasonal semideciduous forests. This vegetation is intensely fragmented and disturbed; despite its importance there are few records of the traditional knowledge of medicinal species.

MATERIAL AND METHODS

Twenty-four residents in the neighborhood of the protected area "Parque Estadual da Cabeça do Cachorro" were interviewed. The residents were questioned about preparation techniques, recommended doses, ways of administration and healing properties of various parts of the plants and were invited to walk through the park to collect in situ some species of plants. The recognized medicinal species were identified and traditional knowledge was systematized. Quantitative indices (Informant Consensus Factor - FIC and Use Value - UV) were calculated.

RESULTS

115 species of medicinal plants belonging to 54 botanical families were cited. Asteraceae (n=14), Fabaceae (n=11), Myrtaceae (n=6), Bignoniaceae, Solanaceae and Verbenaceae (n=5) were the most species-rich. The highest use values were calculated for Achyrocline satureioides, Aristolochia triangularis and Bauhinia forficata (0.63). Moreover, the informants consensus about usages of medicinal plants ranges from 0.024 to 0.663, which shows high level of agreements among the informants for gastro-intestinal and respiratory system diseases. Furthermore, for the first time, new traditional medicinal uses of Asteraceae (Chromolaena pedunculosa Hook. & Arn.), Commelinaceae (Tradescantia fluminensis Vell.) and Polypodiaceae (Microgramma vacciniifolia Langsd. & Fisch.) species were reported.

CONCLUSIONS

Present study revealed that the residents of the surrounding region of forest fragments of Paraná are rich in ethno-medicinal knowledge and rely on plant-based remedies for common health problems. As in many parts of Brazil knowledge of the past is combined with new knowledge that has recently been incorporated emphasizing the cultural changes that this area is experiencing. Despite the use of different species of plants are crucial to their way of life, there is concern that these rich popular knowledge may disappear in the future as a result of a possible modernization of this area.

Medicinal plants of the genus Betula--traditional uses and a phytochemical-pharmacological review

ETHNOPHARMACOLOGICAL RELEVANCE

Trees and shrubs of the genus Betula (Betulaceae) inhabit various ecosystems in temperate and boreal climate zones of the northern hemisphere. The healing properties of Betula bark and bark extracts have been known for a long time in traditional medicine in different parts of the world. Several species of Betula have traditionally been used for the treatment of various inflammatory diseases including arthritis. The purpose of this review is to provide updated, comprehensive and categorized information on the botany, traditional uses, phytochemistry and pharmacological and toxicological research of Betula species in order to explore their therapeutic potential and evaluate future research opportunities.

MATERIALS AND METHODS

All the available information on various species belonging to the genus Betula was collected via electronic search (using Pubmed, SciFinder, Scirus, Google Scholar, JCCC@INSTIRC and Web of Science) and a library search for articles published in peer-reviewed journals.

RESULTS

Although over a hundred Betula species are found distributed globally, about 7 different species of Betula have been documented for their traditional uses. Phytochemical research on Betula species has led to the isolation of triterpenoids, diarylheptanoids, phenylbutanoids, lignans, phenolics and flavonoids. Crude extracts, fractions and phytochemical constituents isolated from Betula showed a wide spectrum of in vitro and in vivo pharmacological activities like immunomodulatory, anti-inflammatory, antimicrobial, antiviral, antioxidant, antidiabetic, dermatological, gastroprotective and hepatoprotective. Antiarthritic and anticancer are the two major areas of research conducted on these species. The anti-carcinogenic effects of Betula bark, betulin as well as betulinic acid have been extensively studied.

CONCLUSIONS

Several species belonging to the genus Betula are widely used in traditional medicine. Betula platyphylla and Betula pendula have specifically been found to be potentially useful in the treatment of degenerative joint disease. There is convincing evidence in experimental animal models in support of their anti-carcinogenic effects. However, it would be worthwhile to investigate the biochemical and physiological mechanisms as well as detailed preclinical toxicity, bioavailability, pharmacokinetics and pharmacodynamics of the different biologically active extracts as well as molecules in sufficient detail. An integrated and holistic approach is required for tapping the full potentials of this important genus.

A cross-cultural analysis of Jammu, Kashmir and Ladakh (India) medicinal plant use

ETHNOPHARMACOLOGICAL RELEVANCE

Jammu & Kashmir (J&K) is a predominantly Himalayan state in the north-western part of India. It has three geographically distinct divisions viz., Jammu, Kashmir and Ladakh, which are immensely rich in their biological and cultural diversity. Medicinal plants are an important element of indigenous medical system of the region. The main goal of the present article is to examine the use of ethnomedicinal plants in three divisions of J&K and to discuss cross-cultural consensus on the use of medicinal plants in these divisions. The article also discusses the gaps in the current state of knowledge on ethnomedicinal plants of the region and gives recommendations for the future studies.

MATERIALS AND METHODS

Scientific literature on ethnomedicinal field studies conducted in J&K state of India available in the journals, edited books and other scientific databases viz., CAB international, DOAJ, Google Scholar, PubMed, Science direct, SciFinder, Scopus and Web of Science were searched. Only field based ethnomedicinal surveys from last four decades up to December 2013 reporting first hand information on the medicinal plants used to treat human health related ailments by indigenous communities of J&K were included in this study. Venn diagram was used to analyze the cross-cultural consensus on the use of ethnomedicinal plants in the three divisions of J&K.

RESULTS

A total of 948 plant taxa (923 angiosperms, 12 gymnosperms and 13 pteridophytes) belonging to 129 families, 509 genera, 937 species and 11 varieties have so far been reported to have a traditional medicinal use by indigenous communities of J&K. Asteraceae (60 genera, 132 spp.) was the most frequently used family followed by Fabaceae (32 genera, 50 spp.) and Lamiaceae (27 genera, 55 spp.). 514, 415 and 397 medicinal plants were used in Jammu, Kashmir and Ladakh divisions, respectively. Sixty eight plant taxa were used in all the three divisions, whereas 95 plants were common between Ladakh and Jammu, 127 plants between Ladakh and Kashmir, and 216 plants between Jammu and Kashmir. Maximum numbers of plant taxa were used for treating dermatological problems (321), followed by cold, cough and throat related ailments (250), fever (224), joint and muscle related ailments (215), gastrointestinal disorders (210), urogenital ailments (199), respiratory ailments (151), body pain (135) and gynecological disorders (127).

CONCLUSIONS

This is the first study from the J&K state, which has examined the medicinal plant use in three divisions of J&K and discussed the promising medicinal plant species with cross-cultural consensus. The analysis of the data suggested that while large numbers of plants are used medicinally in each division, there is a low interregional consensus and high variation between medicinal plants used in these divisions, which is due to both cultural divergence as well as biological distinctness. The issues related to current status of knowledge on medicinal plants used by indigenous communities of J&K have been discussed and some recommendations have been made for future studies on medicinal plants in J&K region.

Mixed Methods in CAM Research: A Systematic Review of Studies Published in 2012

Background. Mixed methods research uses qualitative and quantitative methods together in a single study or a series of related studies. Objectives. To review the prevalence and quality of mixed methods studies in complementary medicine. Methods. All studies published in the top 10 integrative and complementary medicine journals in 2012 were screened. The quality of mixed methods studies was appraised using a published tool designed for mixed methods studies. Results. 4% of papers (95 out of 2349) reported mixed methods studies, 80 of which met criteria for applying the quality appraisal tool. The most popular formal mixed methods design was triangulation (used by 74% of studies), followed by embedded (14%), sequential explanatory (8%), and finally sequential exploratory (5%). Quantitative components were generally of higher quality than qualitative components; when quantitative components involved RCTs they were of particularly high quality. Common methodological limitations were identified. Most strikingly, none of the 80 mixed methods studies addressed the philosophical tensions inherent in mixing qualitative and quantitative methods. Conclusions and Implications. The quality of mixed methods research in CAM can be enhanced by addressing philosophical tensions and improving reporting of (a) analytic methods and reflexivity (in qualitative components) and (b) sampling and recruitment-related procedures (in all components).