Journal of Ethnopharmacology 198 (2017) 268–281

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

Traditional uses of medicinal plants reported by the indigenous MARK

communities and local herbal practitioners of Bajaur Agency, Federally
Administrated Tribal Areas, Pakistan
⁎
Muhammad Abdul Aziza, , Amir Hasan Khanb, Muhammad Adnana, Izatullah Izatullahc
a
Department of Botany, Kohat University of Science and Technologyó, Kohat-26000 Pakistan
b
Department of Botany, Shaheed Benazir Bhuto University Sheringal, District Dir (Upper), Khyber Pakhtunkhwa, Pakistan
c
Otsuka Pakistan Limited, F/4-9, H.T.1.E Hub, Baluchistan, Pakistan

A R T I C L E I N F O A BS T RAC T

Keywords: Ethnopharmacological relevance: In the study area, knowledge related to the traditional uses of medicinal
Medicinal plants plants is totally in the custody of elder community members and local herbalists. The younger generation is
Local herbalists unaware of the traditional knowledge, however with only few exceptions. Therefore, this study was planned with
Folk knowledge objective to document the medicinal importance of plants, conserve this precious indigenous knowledge, and
Use value
share it among other communities through published literature.
Relative frequency of citation
Materials and methods: Data was collected through semi-structured interviews from the community members
Comparative assessment
and local herbalists. The reported plants were collected post interviews and later on pressed on herbarium
vouchers for reference. Afterwards, the data was analyzed through Use value (UV) and Relative Frequency of
Citation (RFC).
Results: In total, 79 medicinal plant species were used for the treatment of different ailments in the study
region. Out of the total plant species, 28 species were not reported from any other mountainous communities
across the country. In this study, the ethno-medicinal value of Opuntia littoralis (Engelm.) Cockerell and Viola
indica W.Becker was reported for the first time, which have moderate confidential level in terms of their
medicinal uses in the study area. Important medicinal plants of the region with high UV are Berberis lycium
Royle (0.94), V. indica (0.90), Isodon rugosus (Wall. ex Benth.) Codd (0.88), Foeniculum vulgare Mill. (0.87),
Peganum harmala L (0.86), Solanum virginianum L. (0.85), and Cassia fistula L. (0.79). Medicinal plants
with higher RFC values are Calotropis procera (Aiton) Dryand. (0.86), Cannabis sativa L. (0.82), Mentha
piperita L. (0.82), Mentha longifolia (L.) Huds. (0.76), Allium sativum L. (0.73), Coriandrum sativum L.
(0.73), and F. vulgare (0.72).
Conclusions: Traditional knowledge on folk medicines is directly linked to the local culture, faith and
perception. This knowledge is gaining high threat of extinction because of its limitation to a small portion of
the society in the region. Therefore, future studies are recommended in similar regions for the documentation of
this precious knowledge. Moreover, our study has also identified some important and newly reported medicinal
plants from the ethno-medicinal perspective, which needs to be studied pharmacologically and toxicologically.

1. Introduction number of pharmaceuticals used in the modern day health care

According to an estimate, there are 350,000 to 400,000 plant
species reported across the world, in which majority are being used
in the treatment of different ailments (Bussmann et al., 2008, 2007;
Paton et al., 2008; Joppa et al., 2010; Abbasi et al., 2010). World health
organization (WHO) has reported that 80% of the world's human
population in third world countries depends on herbal medicines for
their primary health care system (World Health Organization, 2003). A
systems are of plants’ origin and in most cases inspired by the
traditional use (Farnsworth and Soejarto, 1991; Newman and Cragg,
2012). Published reports are describing the trade of medicinal and
aromatic plants as a service with a global value of 60 billion US$
(Hamilton, 2006). This value is expected to substantially expend to a
larger extent by the year 2050 due to the increasing trend and
popularity of herbal medicines (Lange, 1997; Al-Quran, 2008; Khan
et al., 2011).

⁎
Corresponding author.
E-mail addresses: azizmhsd@gmail.com (M.A. Aziz), amirhasankust@gmail.com (A.H. Khan), ghurzang@hotmail.com (M. Adnan), izatullah1990@yahoo.com (I. Izatullah).

http://dx.doi.org/10.1016/j.jep.2017.01.024
Received 7 August 2016; Received in revised form 8 January 2017; Accepted 14 January 2017
Available online 18 January 2017
0378-8741/ © 2017 Elsevier B.V. All rights reserved.
M.A. Aziz et al.
Fig. 1. Map of the study area and location inside Pakistan.
Over the last decades in Pakistan, significant scientific and com-
mercial trends have been observed due to the widespread cultural
acceptability and economic potential of plants’ based products (Sher
et al., 2014, 2015a). Rural population relies more on variety of
traditional herbal remedies due to the lack of access to modern
pharmacopeia (Khan, 2012). Several factors are responsible for the
variation observed in practicing traditional medication that includes
culture, history, attitude and philosophy of communities (Savikin et al.,
2013). The knowledge concerning the preparation of homemade
traditional herbal remedies usually transfer from one generation to
another generation over a period of time (Mahmood et al., 2011b,
2011a, 2011d, 2011c). However, there are equal chances of the
elimination of this precious heritable knowledge going in parallel with
the transfer of knowledge.
Bajaur agency is a part of the Federally Administrated Tribal Areas
(FATA) of Pakistan and comprised of hilly terrain with diversity of
important medicinal plants. Scientific literature is very scarce on the
scope of this study, which is mainly due to the remote nature and lack
of quality education in the study region. Folk knowledge in the study
area is mainly restricted to elder community members and local
herbalists known as “hakims”. Now there is a dire need to document
folk knowledge related to the utilization of medicinal plants before its
extinction. Therefore, this study has been planned with the main
objective to document the ethno-medicinal value of plants, conserve
this precious folk knowledge, and share the information with other
communities through published literature. This study will bring
significant contribution for future research based activities in the fields
of indigenous knowledge conservation, phytochemistry, pharmacology,
and toxicology.
269
Journal of Ethnopharmacology 198 (2017) 268–281
2. Material and methods
2.1. Study area and its socioeconomic background
Bajaur agency is the smallest unit of FATA with hilly terrain
situated at the extreme end of Himalayan range. Bajaur has the
headquarter namely “Khar” and shares approximately 52 km border
with Afghanistan's Kunar province. This border is of great importance
to Pakistan and the entire region. The study area is located at an
altitude of 1126 m asl with E 71° 30′ latitude and N 34° 41′ longitude.
The area is mainly populated by Tarkani Pashtuns tribe, which is sub-
divided into Utman Khel, Mamund, Wur, Salarzai, Tarkalanri and
Safis. The area is dominated by agricultural lands and receiving about
800 mm of average rain falls per annum. The agency is divided into
seven Tehsils known as Barang, Nawagai, Khar, Mamund, Salarzai,
Utmankhel and Chamarkand. Most people are cobblers by profession
while others are teachers, farmers, drivers and running their own
businesses. A high proportion of local populations also obtain remit-
tance from other parts of the country or abroad. The study area has
limited education facilities i.e. three degree level colleges and five
higher secondary schools. There are only two government hospitals
while mostly the people are deprived of modern health facilities. That is
why, people mostly rely on medicinal plants and Hakims. Hence, the
socio-economic status of local people can be improved through the
sustainable harvesting of medicinal plants.
2.2. Ethno-medicinal data collection and ethnographic composition
Field survey was conducted in the months of May and June 2016.
Field visits were carried out prior to data collection on medicinal plants
to ensure and acknowledge the cooperation of indigenous commu-
M.A. Aziz et al. Journal of Ethnopharmacology 198 (2017) 268–281

nities. Mr. Amir Hasan Khan, the local occupant of the area visited 2.4.2. Relative frequency of citation (RFC)
different sites along with a volunteer team and arranged meetings with The ethno-medicinal data recorded during the field survey was
local representatives “Maliks”, to whom purpose of the study was analyzed quantitatively by using the index of relative frequency citation
presented. The local representatives have key roles in dealing various (RFC) as follow:
matters related to society. Survey was conducted through a multi- RFC = FC/N (0 < RFC < 1)
disciplinary team comprising of plant taxonomist and pharmacist from
Shaheed Benazir Bhuto University Sheringal, District Dir (Upper) Where FC is the number of informants mentioning a particular species
Khyber Pakhtunkhwa, Pakistan. Questionnaire was developed to collect while N shows the total number of informants participating in the
folk knowledge from the local healers and aged community members at survey. This index is used to show the local importance of each species
their medical stores and houses, respectively. All the interviews were (Vitalini et al., 2013).
conducted in the local language, “Pashto”. Study objective was shared
with the respondents in order to gain consent and trust, and acknowl- 3. Results and Discussion
edged their participation in a freely environment. Post data collection,
answers were redisplayed to the respondents to avoid errors in the 3.1. Ethno-medicinal flora and status of the traditional knowledge
recordings. among the inhabitants
Data was collected from different sites including Pashat, Tali, Inayat
Kali, Ghar Shamozai, Loe Sum, Barang, Mandai, Khar, Mamund, In total, 79 medicinal plant species belonging to 49 families were
Salarzai. These sites were categorized into foothills villages and catalogued and documented from the study area, which are being used
mountainous villages (Fig. 1). In total, 108 local respondents were in folk remedies for the treatment of various ailments including
selected who belong to different age groups comprising of 84 males and gastrointestinal problems, urinary tract infections, reproductive ail-
24 females including eight local healers (Table 1). Most respondents ments, skeletal system problems and diabetes. All the species were
were farmers, local herbalists and housewives, and their selection was reported from both plain and mountainous areas of the villages. These
based on high reputation in ethno-medicinal knowledge. Continuous plants were generally utilized by the local herbalists for treating
relationships were maintained with locals throughout the survey to patients from the local and nearby communities. It was observed that
ensure validity of traditional knowledge. local people from mountainous areas were more dependent and
confident on traditional medicines as compared to the plain areas’
2.3. Preservation and taxonomic verifications of plant species people. This is mainly due to the introduction of allopathic medicines
into the health care system of plain areas’ villagers and their easy access
Medicinal plants were collected and identified by taxonomist from to modern health facilities. This trend is greatly affecting the local's
the Department of Botany, Shaheed Benazir Bhuto University perception on using traditional medicinal therapies.
Sheringal, District Dir (Upper) Khyber Pakhtunkhwa, Pakistan. In the current investigation, it was found that some of the plants
Botanical names were verified by using the website www.kew.org/ have been reported for one type of disease, while others for different
mpns. Post collection, plants were pressed and dried under the shade, kinds of diseases (Table 2). Occasionally, locally used medicinal herbs
poisoned (1% HgCl2 solution) and mounted properly on the herbarium are bought from other sources such as national markets of the country.
sheets. Voucher numbers were assigned to herbarium sheets and This is not a common practice, however this trend draws attention to
submitted to the aforementioned department as a ready reference. the fact that medicinal plants still maintained their confidence level,
and further stressing the need of cultivation and conservation of such
flora. It was interestingly noted down some gender differences in folk
2.4. Data analysis knowledge on certain medicinal plant species. For instance, female
members interviewed during the current study were using the root
2.4.1. Use value (UV) decoction of Bergenia ciliata (Haw.) Sternb. for the treatment of
This index was used and applied to demonstrate the relative fevers, diarrhea, pulmonary infections and as tonic. Similarly, the
importance of each taxa used by the local communities. The use value female respondents reported the use of Solanum esculentum L. fruits
(UV) was calculated as follow: in blood purification, constipation, skin diseases especially the removal
UV = Σ Ui/N of lesions from the face. On the other side, male informants were totally
unfamiliar on such uses of these plants. In the study region, most of the
where Ui is the number of uses describe by each respondent for a given plants were being used by the indigenous communities against gastro-
species and N shows the total number of respondents taking part in the intestinal diseases. Such findings are in line with studies from Chitral
survey (Phillips and Gentry, 1993). (Sher et al., 2016) and district Matung of Pakistan (Bibi et al., 2014), in
which existence of gastric problems have been indicated as a common
Table 1
issue. Similarly, the prevalence of gastrointestinal problems have been
Showing the number and details of the respondents.
mentioned as the common problems all over the country (Khan et al.,
Category Total % 2014). The existence of such health problems may have been a result of
armed conflicts in the area, lack of proper sanitation arrangements, no
Gender
access to clean water, and inhalation of smoke produced by the fuel
Man 84 77.77
Female 24 22.22 wood. Azizullah et al. (2011) reported in their study that lack of safe
drinking water can be a major cause of water born diseases. Ribeiro
Age groups et al. (2010) reported that gastric problems could result in high
28–40 33 30.55 mortality rate if not properly treated. The gastrointestinal disorders
> 40 75 69.44
are predominant across the globe and a very large number of medicinal
Occupation plants are being used by different cultures to treat such diseases (Ankli
House wives 24 22.22 et al., 1999; Bennett and Prance, 2000; Ridvan et al., 2015). Gastric
Shopkeepers 15 13.88 problems are the utmost use category (Heinrich et al., 1998; Ghorbani
Farmers 35 32.40
et al., 2011; Mosaddegh et al., 2012) due to poor dietary condition and
Labours 27 25
Traditional healers 8 7.40 lack of access to clean water, which are the basic reasons for such
diseases worldwide (Nasab and Khosravi, 2014).

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 Table 2
Medicinal plants use by the indigenous communities of Bajaur Agency. UV=Use value, RFC= Relative frequency of citation, M=Male, F=Female, Hk= Hakim.

Botanical name/Voucher no Family Local name Parts used Medicinal value UV RFC Reported from Reported by
M.A. Aziz et al.

M F Hk

Acacia modesta Wall./AWK−127 Mimosaceae Palosa Leaves and latex The leaves are used as blood purifier, abdominal pain and redness. Gums 0.60 0.45 Mountain area – – +
of the plant are used as sexual tonic.
Acacia nilotica (L.) Delile/AWK−137 Leguminosae Kikar Flower and fruit The powder is used against diarrhea, throat infection, fever and cough. 0.70 0.27 Plain area – – +
Achyranthes aspera L. /AWK- 101 Amaranthaceae Jeshy Whole plant The powder is used to treat cough. The infusion of the plant is used in 0.68 0.51 Plain area + – +
pneumonia. Paste is applied topically to treat skin allergy.
Acorus calamus L. /AWK- 102 Acoraceae Skha waja Roots and leaves Decoction of the plant is used for the treatment of general body pain. 0.44 0.32 Mountain area + – +
Ajuga integrifolia Buch.-Ham. ex D.Don Lamiaceae Guttee Leaves and roots The decoction of leaves and roots is used for cooling and soothing effects. 0.38 0.27 Mountain area + – +
/AWK−139 The plant is also used as stimulant, astringent and diuretic. The decoction
of its root is used to treat abdominal pain, blood purification and kidney
pain.
Allium sativum L./AWK−128 Amaryllidaceae Garlic Bulb Garlic is medicinally used to maintain blood pressure and diabetes. 0.66 0.73 Plain area + + +
Artemisia absinthium L./AWK−143 Asteraceae Spairo botay Whole plant The plant is used as stomachic and anthelmintic. 0.37 0.36 Mountain area – – +
Artemisia vulgaris L./AWK−115 Asteraceae Tarhkha Leaves Leaves of the plants are used for killing intestinal worms and blood 0.13 0.18 Plain area – + +
clotting.
Berberis lycium Royle/AWK−116 Berberidaceae Koray Root The decoction of the plant is used in cooling effect. Root powder is used in 0.94 0.55 Mountain area + – +
jaundice, internal wounds, mouth disease and as antispasmodic.
Bergenia ciliata (Haw.) Sternb./AWK−133 Saxifragaceae Kamar panra Roots The decoction of root is used in fever, diarrhea and pulmonary infections, 0.53 0.45 Mountain area – + –
cough, cold and as tonic.
Brassica cadmea Heldr. ex O.E.Schulz/ Brassicaceae Sharsham Seeds and leaves The extracted oil is utilized for body massage and hair massage. This oil is 0.49 0.64 Plain area + + +
AWK−142 also used in cooking while its leaves are used as fodder.
Calendula arvensis (Vaill.) L. /AWK−135 Asteraceae Shodapai Leaves The leaves are used as stomachic, abdominal pain and as carminative. 0.22 0.45 Plain area – + –
Calendula officinalis L./AWK−122 Asteraceae Dambar guly Flowers Fresh flowers are used in fever, stomach pain, and against the wasp bite. 0.58 0.18 Plain area + + +
Calotropis procera (Aiton) Dryand./ Apocynaceae Spalmai Latex and flower Latex is used for tooth pain and abdominal pain. It is topically applied for 0.61 0.86 Plain area + + +

271
AWK−157 wasp, snake and scorpion bites. The plant is also used in chest problems.
Flowers of the plant are taken with water and used in kidney stones.
Cannabis sativa L./AWK−146 Cannabinacaeae Bang Whole plants and Leaves are used as narcotics, sedative, analgesic, antispasmodic, diuretic 0.52 0.82 Plain area + + +
fruits and astringent. Decoction of the whole plant is used as cooling agent.
Cassia fistula L./AWK−129 Leguminosae Amaltas Fruits Fruit of the plant is used for children to treat intestinal pains. It is also 0.79 0.27 Plain area + + +
used in body pain, constipation and fever.
Cedrus deodara (Roxb. ex D.Don) G.Don/ Pinaceae Nianzra Stem Oil obtained for its stem is used for cooling effect. 0.42 0.36 Mountain area – – +
AWK−119
Celtis caucasica Willd. /AWK- 203 Cannabaceae Tagha Bark Bark powder is used in wound's healing caused due to burning fire. 0.54 0.48 Mountainous area + – +
Chenopodiastrum murale (L.) S.Fuentes, Chenopodiaceae Sowhanay Leaves and seeds The powder of leaves is used as purgative, emollient, anthelmintic, 0.59 0.64 Mountain area – – +
Uotila & Borsch /AWK−151 tranquilizer, and as tonic. Powder of the seed is used for the treatment of
liver problems, digestive problems, as carminative, and aphrodisiac. The
plant is also useful in treating peptic ulcer, dyspepsia, hemorrhoids,
cardiac disorder and opthalmopathy. Seed and leaves powder are also
laxative and used in vitiated conditions of spleen.
Coix lacryma-jobi L. /AWK- 202 Poaceae Tasfa botay Fruit and leaves Fruit and leaves decoction is used for the removal of kidney stones, 0.58 0.49 Mountainous area – – +
treatment of rheumatism, joint pains, and as cooling effect.
Conyza canadensis (L.) Cronquist/ Asteraceae Shkandar botay Whole plant The plant is used as anti diabetes. 0.55 0.18 Mountain area + – +
AWK−124
Coriandrum sativum L./AWK−126 Apiaceae Danya Leaves and fruits The leaves and fruit are used in digestive problems. The plant is also 0.64 0.73 Plain area + + +
utilized as cooling agent, diuretic and stimulant.
Cuscuta reflexa Roxb./AWK−154 Cuscutaceae Machai Whole plant The whole plant is used as anti-diabetes. 0.39 0.27 Plain area – – +
Daphne mucronata Royle /AWK−201 Thymelaeaceae Laighonai Fruits The fruit is used to stop the running stool and clean the abdomen. 0.67 0.58 Plain area + + +
Datisca cannabina L./AWK−200 Datiscaceae Jal bhang Roots Root decoction is used for tooth pain, joint pain, and general body pain. 0.41 0.39 Mountainous area – – +
Datura metel L./AWK−138 Solanaceae Batura Leaves The leaves are used in treating diarrhea and dysentery. Leaves are also 0.47 0.55 Mountain area – – +
poisonous.
Desmodium elegans DC. /AWK−188 Fabaceae Daghar Roots and leaves Juice extracted from its root is used for earache, stomach pain, and joint 0.61 0.55 Mountainous area + – +
shencahi pain.
Dodonaea viscosa (L.) Jacq./AWK−136 Sapindaceae Ghawrasky Leaves Powder of the plant is used against Hepatitis, swelling, burns and 0.17 0.18 Mountain area – – +
(continued on next page)
Journal of Ethnopharmacology 198 (2017) 268–281
 Table 2 (continued)

Botanical name/Voucher no Family Local name Parts used Medicinal value UV RFC Reported from Reported by
M.A. Aziz et al.

M F Hk

rheumatism.
Duchesnea indica (Jacks.) Focke Rosaceae Da Zamaky Fruits The fruit of the plant is laxative. 0.36 0.27 Plain area + – +
/AWK−147 Toot
Dysphania botrys (L.) Mosyakin & Amaranthaceae Kharawa Whole plant The powder of the plant is used to enhance digestive power. Decoction is 0.41 0.27 Mountain area – – +
Clemants./AWK−140 used for the expulsion of worms and is laxative.
Equisetum arvense L. /AWK−189 Equisetaceae Bandakay Whole plant Plant powder is used to remove kidney stones. 0.48 0.51 Mountainous area – – +
Eucalyptus camaldulensis Dehnh./ Myrtaceae Lachi Leaves Leaves of the plant is used to remove bad smell from mouth, and also 0.41 0.45 Mountain area – – +
AWK−155 effective in asthma.
Euphorbia helioscopia L. AWK−145 Euphorbiaceae Mandaru Whole plant Whole plant is purgative. The herb is also used for chest infection, cough, 0.15 0.27 Mountain area – – +
dysentery, stomach pain, and used for the killing of intestinal worms.
Euphorbia wallichii Hook.f./AWK−117 Euphorbiaceae Arbay Shoot and Used against intestinal worms 0.11 0.45 plain area – – +
Inflorescence
Ficus carica L. AWK−130 Moraceae Inzar Fruits and leaves Leaves and stem are crushed, and used against warts. The fruits of the 0.49 0.27 Plain area + + +
plants are used for stomach pain and toothache. Three figs are taken orally
and considered as nutritive. The fruit is also used as demulcent, emollient
and as laxative, and in the purification of blood.
Foeniculum vulgare Mill./AWK−118 Apiaceae Kagilani Leaves, stem and Leaves and stem are used as antipyretic and headache. The fruit is used 0.87 0.72 Plain area + + +
fruits against diarrhea, stomach pain, indigestion and vomiting.
Grewia optiva J.R.Drumm. ex Burret Malvaceae Pastwony Pastwony Whole plant Plant powder is used for the intestinal problems and skin allergy. 0.68 0.59 Mountainous area – – +
/AWK−199
Indigofera heterantha Brandis/AWK−141 Fabaceae Ghoreja Roots Root powder is used for the breakdown of kidney stone. The decoction of 0.44 0.27 Mountain area – – +
roots is used for belly and stomach pain.
Isodon rugosus (Wall. ex Benth.) Codd/ Lamiaceae Spairkay Seed and leaves Seed powder and paste prepared from leaves is applied on external wounds 0.88 0.45 Mountain area + – +
AWK−152 for blood clotting. It is also used to remove the infections caused by fungus

272
in mouth.
Juglans regia L./AWK−123 Juglandaceae Ghuz Root, bark and Bark is used as “Dandassa’’ for cleaning of teeth. Fruit is used as brain 0.71 0.36 Mountain area + + +
fruits tonic. Leaves are astringent and used as tonic.
Lotus corniculatus L. /AWK- 198 Fabaceae Fateh khana Whole plant Plant powder is used for the removal of kidney stones. Its decoction is used 0.69 0.64 Mountainous area – – +
as diuretic and used for the treatment of urinary tract infection.
Mallotus philippensis (Lam.) Müll. Arg. / Euphorbiaceae Kambela Plant powder The plant powder is used in wound healing. 0.41 0.38 Mountainous area + – –
197
Marubium vulgare L./AWK−156 Labiatae Qurashka Whole plant The whole plant is used as tonic, expectorant, diuretic. The herb is also 0.38 0.48 Plain area + – +
beneficent for pulmonary infections and cold.
Melia azedarach L./AWK−125 Meliaceae Tora Bakyana Leaves, bark and Dried leaves are used in diabetes. The decoction of roots is effective in 0.55 0.36 Plain area + – +
fruits chest diseases and lice killing.
Mentha longifolia (L.) Huds. /AWK−120 Lamiaceae Velany Leaves The leaves powder is use against vomiting, pain, fever. The fresh leaves are 0.68 0.76 Plain area + + +
used in constipation, stomach disorders and diarrhea
Mentha piperita L./AWK−148 Lamiaceae Podina Leaves The plant is used as carminative and for gastric problems. Leaves are also 0.66 0.82 Plain area + + +
used as stimulant, in vomiting, liver problems and gallbladder infections.
Morella esculenta (Buch.-Ham. ex D.Don) Myricaceae Gusai Whole plant Powder is used as purgative and treat digestive problems. Also used for 0.51 0.70 Mountainous area + – +
I.M.Turner /AWK−196 lung problems.
Morus nigra L./AWK−131 Moraceae Tor toth Fruits Fruit is used for cooling effect. Phlegm is minimized by using the fruit. It is 0.54 0.36 Plain area – – +
also used in sore throat and to overcome iron deficiency.
Myrsine africana L./AWK−158 Myrsinaceae Manogaya Leaves and seeds The powder of its leaves is used as blood purifier, anthelmentic, laxative, 0.47 0.18 Mountain area + – +
gas problem, tooth ache, and bone pain
Myrtus communis L./AWK−159 Myrtaceae mano Leaves and fruits Powdered leaves and fruit are used for the treatment of cholera, dysentery, 0.19 0.27 Plain area + – +
diarrhea and stomach pain.
Nasturtium officinale W.T.Aiton/ Cruciferae Tarmera Whole plant The plant is a good appetizer and used as vermifuge, stimulant, 0.51 0.27 Plain area – – +
AWK−149 antispasmodic, expectorant, and in gastric problems. The infusion is used
as diuretic.
Nerium oleander L./AWK−132 Apocynaceae Gandiray Leaves and flowers The leaves are considered as poisonous. Infertility is treated by using the 0.46 0.36 Plain area – – +
leaves.
Nigella sativa L./AWK−121 Ranunculaceae Klonji Seeds Seeds are specially used as sexual tonic. It is also used for lactation and 0.68 0.45 Mountain area + + +
(continued on next page)
Journal of Ethnopharmacology 198 (2017) 268–281
 Table 2 (continued)

Botanical name/Voucher no Family Local name Parts used Medicinal value UV RFC Reported from Reported by
M.A. Aziz et al.

M F Hk

decrease mental disturbances.

Ocimum basilicum L./AWK−134 Labiatae kashmaly Leaves, seeds The paste prepared form its leaves is used for swelling and redness. Seed 0.72 0.55 Mountain area – – +
powder is used in throat problem.
Olea ferruginea Wall. ex Aitch./AWK−150 Oleaceae Khona Leaves, bark Bark and leaves of the plant are astringent, bitter, diuretic, and antiseptic. 0.41 0.36 Mountain area + + +
Leaves are used as tonic, while its decoction in toothache. Its oil is
beneficial in constipation, rheumatism and dandruff.
Opuntia littoralis (Engelm.) Cockerell/ Cactaceae zuqam Whole plant Whole plant is used against hepatitis, muscle pain and inflammation. 0.67 0.58 Mountain area + – +
AWK−160
Origanum majorana L./AWK−194 Lamiaceae Da ghar Aerial parts Powder is used for treating blood pressure and general body pain. 0.69 0.61 Mountainous area – – +
kashmaly
Paeonia emodi Royle/AWK−195 Paeoniaceae Mamekh Rhizome Rhizome powder is used as sexual tonic, general body tonic and treating 0.68 0.55 Mountainous area + – +
abdominal pain.

Peganum harmala L Zygophyllaceae Sponda Fruit and seeds Fruit of the plant is used for heart pain. Seed power mixed with honey is 0.86 0.45 Plain area – – +
AWK−168 used against fever, colic pain and as vormifuge.
Pinus gerardiana Wall. ex D.Don/ Pinaceae Nakhtar Fruit Fruit is used against diabetes and considered a powerful tonic for brain. 0.53 0.64 Mountain area + – +
AWK−166 People use the fruit as a hot nutritive food during the winter season.
Pistacia integerrima Stewart ex Brandis Anacardiaceae Shanay Fruits The fruit is used to treat cough and as analgesic. The fruit is also used 0.70 0.68 Mountainous area + + +
/AWK−193 topically against stings and wasp bite.
Plantago ovata Forssk./AWK−174 Plantaginaceae Ispaghol Seeds Seeds are used for weight loss, headache and dysentery. 0.69 0.55 Mountain area – – +
Platanus orientalis L./ AWK−192 Platanaceae Chinar Bark The powder of bark is used in the treatment of internal and external 0.51 0.44 Plain area – – +
infections.
Punica granatum L./AWK−153 Lythraceae Anar Bark Bark powder is used for children who wet (pee) their beds during 0.51 0.45 Plain area + + –
nighttime.

273
Quercus baloot Griff./AWK−176 Fagaceae Saray Fruits Fruit is used for the treatment of hemorrhages. Chronic diarrhea and 0.52 0.45 Mountain area – – +
dysentery is also treated by using its fruits powder.
Ricinus communis L./AWK−162 Euphorbiaceae Randa Leaves and fruits Leaves powder and fruit are used in joint pain, asthma and diarrhea 0.54 0.36 Plain area – + –
Rubus fruticosus auct. [L.] /AWK−191 Rosaceae Khwrach Fruit and leaves Fruit powder and leaves are used for intestinal pain, and given to the 0.51 0.45 Plain area – – +
diabetic patient.
Rumex crispus L./AWK−171 Polygonaceae Shalkhay Leaves and fruits Leaves are used for blood purification, and as laxative. Anemia, dysentery 0.38 0.36 Plain area – – +
and stomach pain are also treated by using the leaves powder. It is also
used as tonic. Fruit is used for the infection. Low blood pressure is
increased by using the plant.
Rumex hastatus D. Don/AWK−163 Polygonaceae Trokay Whole plant To control blood pressure, the plant juice is used for controlling the blood 0.64 0.18 Mountain area + – –
pressure. The root powder is beneficial to treat abdominal pain. Leaves are
also used as condiments.
Solanum esculentum L. L. /AWK−144 Solanaceae Tamater Fruits Fruits are used in blood purification, constipation, hepatitis, anorexia and 0.56 0.45 Plain area – + –
skin diseases.
Solanum nigrum L./AWK−175 Solanaceae Kamchu Aerial parts The aerial parts are used for weight loss, as purgative and sedative. 0.53 0.45 Plain area – – +
Solanum virginianum L. /AWK−161 Solanaceae Markonday Roots, leaves and The roots powder and leaves are used for toothache and tooth worms. The 0.85 0.64 Plain area – – +
fruits decoction of fruits is used against fever.
Trachyspermum ammi (L.) Sprague/ Apiaceae Ajwain Seeds Abdominal pain is treated by taking the seeds powder 0.71 0.71 Plain area + + +
AWK−164
Viola indica W.Becker/AWK−165 Violaceae Benowsha Leaves and flowers The juice of leaves is used for treating internal body wounds. The leaves 0.9 0.55 Mountain area – – +
powder is used for cough, asthma, fever, and chest problem. The plant is
antipyretic, diaphoretic, and is used as refrigerant. Flowers are used as
demulcent, diuretic, emollient, and as laxative.
Withiana somnifera L./AWK−172 Solanaceae Koti lal Roots The roots powder is used in anxiety and hypertension. It increases the 0.94 0.64 Plain area + + +
sexual power and used as antipyretic, tonic, and internal body infections.
Xanthium strumarium L./AWK−190 Asteraceae Jishkay Leaves, flower and The leaves and flowers powder is used to treat chest problems. Seeds are 0.66 0.68 Plain area + – +
seeds used in stomach problem, and swelling of abdomen.
Zanthoxylum armatum DC./AWK−173 Rutaceae Dambara Seeds Seed powder is used for the treatment of gastrointestinal, respiratory and 0.57 0.36 Mountain area – – +
cardiovascular disorders.
(continued on next page)
Journal of Ethnopharmacology 198 (2017) 268–281
M.A. Aziz et al. Journal of Ethnopharmacology 198 (2017) 268–281

The current study recorded different methods of administration and

Hk

+
preparation of herbal remedies by the local herbalists (hakims) at
Reported by

various sites, which are quite simple and basic. In terms of oral use of
–

–
F

herbal recipes, mainly the plant powder ingested with water, decoction
and very rarely juice extracts were used in the study area. This has also
M

– been indicated by the researchers from different parts of the world

(Abbasi et al., 2013; Ridvan et al., 2015;). On the other side, the paste
Mountain area
Reported from

and ground herbs were extensively used to treat a particular dermal

Plain area

disease. Survey also indicated that aged people in the locality have
sufficient knowledge but the practice of herbal remedies inside house-
holds is almost at the verge of extinction. Several factors including the
0.45

0.64
RFC

introduction of allopathic medicines, modernization, easy access to

local herbal practitioners, and emergency situation (accident, birth,
0.45

0.58

major illness, surgery etc) (Sher et al., 2016) may be preventing locals
UV

from the preparation of herbal therapies at homes because they

Root powder and decoction are used in hepatitis. The plant is also effective

consider it as a time consuming task. However, mostly people residing

Fruit of the plant is used in blood purification as anti-allergy, and for

in the mountainous areas still rely on hakims for the treatment of

minor diseases, especially gastric problems and sexual complexities.
chronic constipation. Fruits also given to the diabetic patients.

This is mainly due to the local perception that Unani and Aurvedic
medicines have no toxic effects. The local herbalists have great knowl-
edge on traditional herbal medications, however they were least
interested to share the knowledge. Here arises a great concern of less
or no transmission of this knowledge to the coming generations, which
would ultimately result in the extinction of this valuable indigenous
knowledge.
Evaluating the existing traditional knowledge, it was found that
elder family members of the communities have sufficient knowledge as
compared to the younger ones in the study area. Moreover, literate
people were less conversant towards the use of traditional therapies as
compared to illiterates. Mostly, the male family members were inter-
viewed because interviewing female community members is somewhat
Medicinal value

difficult due to gender segregation, veil (Parda) and shame according to

in diabetes.

the religious and local traditions just like other parts of the country
(Ahmad et al., 2014; Sher et al., 2016).

3.2. Use value and comparative analysis of important medicinal

plants

To evaluate the local importance of any species, Phillips and Gentry

Parts used

(1993) proposed and devised a formula called use value. Greater use
Fruits

Roots

value implies higher importance of that specific plant species and vice
versa. However, the use value cannot specify and distinguishes the fact
that whether a plant species is used for a single or multiple purposes
Local name

(Musa et al., 2011). In the current study, use value ranged between
Markhnai

0.11 to 0.94, in which the highest value was recorded for B. lycium
Elanai

(0.94) followed by V. indica (0.90), I. rugosus (0.88), F. vulgare (0.87),

P. harmala (0.86), S. virginianum (0.85), and C. fistula (0.79). This
enlightens the fact that these plants are commonly used in the local
traditional pharmacopeia (Table 2). On the other side, minimum use
Rhamnaceae

Rhamnaceae

value was recorded for Euphorbia wallichii Hook.f. (0.11) followed by

Artemisia vulgaris L (0.13) Euphorbia helioscopia L. (0.15),
Family

Dodonaea viscosa (L.) Jacq. (0.18), Myrtus communis L. (0.19)

Calendula arvensis (Vaill.) L. (0.22), and O. littoralis (0.67).
Relative frequency of citation (RFC) value was also recorded for
Ziziphus nummularia (Burm.f.) Wight &

each plant species. RFC directly depends on the number of informants

reported that specific plant species, indicating the local importance.
Ziziphus jujuba Mill./AWK−169

Highest RFC value was found for C. procera (0.86) followed by C.

sativa (0.82), M. piperita (0.82), M. longifolia (0.76), A. sativum
Botanical name/Voucher no

(0.73), C. sativum (0.73), and F. vulgare (0.72) (Table 2). Local

herbalists use these plants for the treatment of patients even coming
Arn./AWK−170
Table 2 (continued)

from the nearby localities. All the communities also use these plants
(indicated by their high use value and high RFC value) for the
treatment of different diseases.
In the current study, decoction of B. lycium is used for cooling
effect. In addition, the root powder is used in jaundice, internal
injuries, mouth diseases, and as antispasmodic. Powdered seeds and

274
M.A. Aziz et al.
leaves of I. rugosus is used for external wounds and blood clotting. F.
vulgare leaves and stem are used as antipyretic and headache. Its fruits
are used for treating diarrhea, stomach pain, indigestion, vomiting and
healing mouth infections. The P. harmala fruits are used for heart pain
while its seed power mixed with honey is used against fever, colic pain,
and as vermifuge. Similarly, root and leaves’ powder of S. virginianum
is used for tooth pain while its fruits’ decoction is effective in fever.
Duchesnea indica (Jacks.) Focke is used as laxative, effective in the
treatment of constipation and stopping the running stole. Previous
literature is showing more or less similar uses of the aforementioned
plants. As an example, powdered obtained from the root bark of B.
lycium is given orally as a tonic (Akhtar et al., 2013) while its decoction
is used for the treatment of jaundice and fever. B. lycium has been
reportedly effective in jaundice, diarrhea, piles, dysentery, earache,
backache, eye infections (Abbasi et al., 2005, 2009; Zabihullah et al.,
2006; Sher et al., 2016). Similarly, dried leaves of I. rugosus are kept in
mouth for toothache (Akhtar et al., 2013). The seeds and shoots of this
plant species are boiled in water and given orally for the treatment of
skin diseases, blood purification, and gastric problems (Ahmad et al.,
2014). F. vulgare fruits are grounded and mixed with sugar for taking
orally along milk in the treatment of urinary tract infections. Moreover,
its dry fruit is also carminative and used as laxative (Akhtar et al.,
2013). In addition, its seeds are crushed and taken orally with water for
treating flu, abdominal pain and bronchitis (Sher et al., 2016). Leaves
and seeds of P. harmala are burned for inhalation, which are spiritually
considered to repel and remove the effect of bad evil and or an evil eye
(locally called Bad Nazar) (Sher et al., 2016). Additionally, its leaves’
decoction is used against abdominal worms, backbone ache and as
aphrodisiac. Seeds’ decoction is prepared in the olive oil for the
treatment of deafness while whole plant fumigation is used for tooth-
ache, measles, and chicken pox. The seeds also carry antioxidant
property (Arshad et al., 2014) and regarded as narcotics, antispasmo-
dic, emetic, alterative and hypotonic (Ullah et al., 2013). Furthermore,
the seeds’ powder of P. harmala is used for colic pain, jaundice,
asthma, as anthelmintic and helpful in lowering the body temperature
during chronic malaria (Ullah et al., 2013). Similarly, the leaves’
decoction of S. virginianum is used for the treatment of anorexia
while stem, root and leaves decoction is utilized as a cooling agent. The
dry fruit is used for the removal of intestinal worms, treating stomach
diseases, pimples, and also given to the diabetic patient (Arshad et al.,
2014). The decoction prepared from the leaves of D. indica is very
effective in the treatment of throat ache and cough with some other
reports as well in treating diarrhea, pyelitis and pharyngitis (Lee et al.,
2008; Zuoa et al., 2008; Qiao et al., 2009).
There are certain other plants, which have been mentioned in
different studies for the treatment of various ailments by different
communities. B. ciliata has been reported in a number of studies for
being as aphrodisiac, antiseptic, used against boils, demulcent, treating
fever, astringent, muscular pain and as tonic (Haq and Rehman, 1990;
Shah and Khan, 2006). S. esculentum is utilized for the treatment of
eye infections in chickens (Mwale et al., 2005). Nerium oleander L. is
used for the treatment of leprosy and other skin related diseases (Haq
and Rehman, 1990). Ziziphus nummularia (Burm.f.) Wight & Arn. is
used for the treatment of throat infection, cough, cold and as sedative
(Haq and Hussain, 1995). Juice extract of A. sativum is frequently
utilized by the local herbalists to treat ear infections because of its
potential activities against bacteria, viruses and fungi (Hughes and
Lawson, 1991; Braun and Cohen, 2010). If a plant is used to treat the
same disease in different parts the world, then it is pharmacologically
more effective and can be explored (Çakılcıoğlu et al., 2011). Our study
has reported the traditional uses of O. littoralis and V. indica for the
first time for which no record was found from any previous ethno-
medicinal studies. O. littoralis is used against hepatitis, as antispas-
modic, muscle pain and anti inflammation while the leaves’ juice of V.
indica is used for treating internal body wounds. The leaves’ powder of
V. indica is also used for cough, asthma, fever, and chest related
275
Journal of Ethnopharmacology 198 (2017) 268–281
problem. Moreover, this plant is also being used as a cooling agent,
antipyretic and diaphoretic while its flowers have laxative, diuretic and
emollient effects. Other than these two plants, there have been newly
reported medicinal uses of certain aforementioned medicinal plants.
This includes B. lycium use in mouth disease; I. rugosus uses in
external wounds and blood clotting; P. harmala use in heart pain; S.
virginianum use in tooth pain; D. indica uses as laxative, and in
constipation or stopping running stole.
3.3. Phytopharmacological and toxicological evidence of medicinal
plants
Previously published scientific reports were thoroughly reviewed for
getting an insight into the pharmacological, phytochemical, toxicolo-
gical and other medicinal properties of the documented ethno-medic-
inal plant species.
C. procera has reportedly containing certain important phytochem-
icals such as calotoxin, calotropin, trypsin, voruscharin, calactin,
uzarigenin, syriagenin, proceroside, benzoylisolineolone, benzoyllineo-
lone, cyaniding-3-rhamnoglucoside (Rastogi and Mehrotra, 1993). In
our study, C. procera is utilized for the treatment of various health
disorders such as tooth pain, abdominal pain, wasp, snakebite,
scorpion bite, chest problems, and removal of kidney stones. Studies
have shown that the ethnanolic and aqeous extracts of leaf/ latex of this
plant are carrying inhibitory activities against certain fungul and
bacterial strains, and the latex also possess anti-inflammatory potential
(Kumar and Roy, 2007). Moreover, experimental validation of C.
procera against snakebites (Jain et al., 1996), dermal problems
(Rasik et al., 1999) and respiratory tract infections (Dey and De,
2012) has already been carried out. Although the plant is used
medicinally for treating different infections, however there are certain
studies that are reporting the toxic side effects of C. procera including
lesions, blisters, and eruptions when the plant is taken by the patient
for the treatment of gastrointestinal and joint pain. An important
phytochemical known as calotropin found in the latex of C. procera is
considered to be responsible for slowing the heart beat and gastro-
enteritis if injected into the lymph sac of a frog (Sharma, 1934).
Moreover, higher dose of C. procera can cause skin irritation, bullous
dermatitis, slow but very strong heart beat, respiration problem,
increased blood pressure, convulsion and even death (Crout et al.,
1963; Duke, 1986).
Traditionally in the study area, P. harmala is used in heart pain,
fever, colic pain and as vormifuge. The traditional uses of the plant can
be justified by the reported pharmacological actions of the plant. P.
harmala is also used traditionally as abortifacient and as emmenago-
gue in different medicines (Boulus, 1983). Studies have indicated that
biologically active components found in P. harmala are quinazoline
alkaloids (vasicine and vasicinone), which are responsible for abortifa-
cient activity (Shapira et al., 1989) and for the first time isolated from
the flowers and stem of this plant (Madadkar et al., 2002). Harmaline
(harmidine) and harmine are also important chemical compounds of P.
harmala where pharmacologically harmine resembles harmaline in its
action, but is less toxic. Hydrochloride present in the plant is very
effective against Mycobacterium tuberculosis (Glasby, 1978). Other
compounds including β-carboline alkaloid, pegamine and harmalidine,
which are similar to the quinazoline alkaloids have been extracted and
isolated from the aerial parts and seeds of this plant (Sharaf et al.,
1997). Several studies have proved that P. harmala have insecticidal,
anti-tumor, anti-malarial, anti histaminic, antispasmodic, vasorelax-
ant, antioxidant, wound healing, immunomodulator, anti-leishmanial,
analgesic, antinociceptive, anti-inflammatory, hypoglycemic, and he-
patoprotective properties (Singh et al., 2008; Khaled et al., 2008; Goel
et al., 2009). Overdose of P. harmala may produce different signs and
symptoms such as nausea, vomiting, hallucinations, neurosensorial
syndromes, gastrointestinal disturbances and braycardia (Madadkar
et al., 2002). Similarly, harmaline and harmine are toxic chemicals
M.A. Aziz et al.
present in the plant and are responsible for the formation of tremors
and clonic convulsions (Budavari and O‟Neil, 1996). Lethal doses of
the plant products may bring convulsions very rapidly, which may
follow by motor paralysis because of the distinct depression action
upon the central nervous system (CNS). The intravenous injection of
harmaline and harmine (9 mg/kg) has shown toxic effects in cattle
including clonic muscular spasms, accelerated breathing and pulse
(Puzii et al., 1980).
The leaves and stems of F. vulgare are used as antipyretic, and for
headache while fruit of the plant is used against diarrhea, stomach
pain, indigestion and vomiting. The plant has important chemical
compounds like estragole, anethole (and its polymer such as photo-
anethole and dianethole), (+) Fenchone and P-anisaldehyde, which are
considered as biologically active components comprising oestrogenic,
antithrombotic and acaricidal activities. Phenolic compouds inside the
plant have been proved to have antioxidant effects in diverse experi-
ments (Rather et al., 2012). Earlier research has proven that a
compound namely estragole isolated from F. vulgare have species
specific effect, sex specific effect and cause carcinogenicity in tissues,
which may be because of its metabolic activation (Miller et al., 1983;
Phillips, 1994; Paini et al., 2010). Punt et al. (2008) describe that
estragole metabolism is dependent on the quantity of dose, which could
result in the formation of mutagenic metabolits if taken in higher
doses. In the same way B. lycium contain alkaloids including barberine
(Gosh et al., 1990), plamitine (Gulfraz et al., 2004), berbamine (Khare,
2004), baluchistanamine, karakoramine, gilgitine, jhelumine, punja-
bine, sindamine, chinabine (Manske, 1998), umbellatine (Baquar,
1989), vitamin C, carbohydrates, protein, lipids (Gulfraz et al., 2004;
Sood et al., 2010), saponins, hydrolysable tannins, and cardioactive
glycosides (Ahmad et al., 2009). Most of these compounds or plant
extracts carry different pharmacological activities such as antibacterial,
antifungal (Singh et al., 2007), immunostimulant, anticoccidial
(Nidaullah et al., 2010), antimutagenic (Khan et al., 2010), hypogly-
cemic (Gulfraz et al., 2007, 2008; Ahmad et al., 2009a), antihyperlipi-
demic (Chand et al., 2007; Ahmed et al., 2009b), hepatoprotective
(Khan et al., 2008), and wound healing properties (Asif et al., 2007).
These pharmacological properties provide justification for the tradi-
tional utilization of B. lycium by the indigenous communities such as
for cooling effect, against jaundice, internal wounds, as antispasmodic,
and treating mouth diseases. Berberine particularly has antidiarrheal
(Zhang and Sheg, 1989), antinocioceptive, antipyretic (Küpeli et al.,
2002), anti-inflammatory (Kuo et al., 2004), anti hypercholesterolemia
(Doggrell, 2005), antitumor (Issat et al., 2006) and anti diabetic
properties (Steriti, 2010).
In addition to the aforementioned scientific reports validating the
traditional uses of medicinal plants, other important plants have also
been investigated for their phytochemical, biological and toxicological
potential. These included medicinal plants such as Acorus calamus L.,
Cuscuta reflexa Roxb., Dodonaea viscosa (L.) Jacq., Punica granatum
L., Ricinus communis L., B. ciliata, C. fistula, C sativa, and Z.
nummularia. However, there are certain studied medicinal plant
species including Celtis caucasica Willd., Dysphania botrys (L.)
Mosyakin & Clemants., Pinus gerardiana Wall. ex D.Don. and O.
littoralis, have scarce pharmacological and toxicological reports.
More attention is required to use medicinal plants in a safe and
secure way because such products are of great health concerns. A more
recent study in Pakistan has reviewed the elemental contents (macro-
and trace) of 69 medicinal plant taxa, which are being ethno-medicin-
ally used against various ailments including anemia, jaundice, cancer,
diarrhea, dysentery, diabetes, asthma, ulcer etc (Aziz et al., 2016). The
study indicated that the elemental contents of certain medicinal plants
were exceeding the WHO permissible limits, which may produce toxic
consequences to human bodies. Despite this fact, the preparation of
herbal products is preferred because of the locals’ perception that they
have no or less risks of carcinogenicity, teratogenicity mutagenecity,
other minimal toxicities and side effects. Though toxicological studies
276
Journal of Ethnopharmacology 198 (2017) 268–281
on some medicinal plants have also proven that there are certain
chemical compounds present in herbal products having the potential to
produce toxic effects inside living organisms, therefore many questions
still remain unanswered regarding the traditional use of medicinal
plants. So far, many compounds have been isolated from a variety of
medicinal plants around the globe, however the biological (in vitro, in
vivo) and toxicological activities of majority of these compounds still
remains unexplored particularly in relation to their ethno-medicinal
knowledge. Therefore, the integration of traditional herbal products to
modern day drugs, clinical trials and pharmacognostic validation of
biologically active ingredients should be subjected in the new health
care systems. The integration of traditional herbal products with the
safety and security of these products can be justified by the European
Directive of Traditional Herbal Medicinal Products, which is a model
mentioning the fact as how reports relating to the traditional uses and
secure profile can be sufficient to maintain herbal medicines for safer
usage (Cox and Roche, 2004). Moreover, it is equally important to
analyze and evaluate the possible potential of herb-drug for safety and
efficacy. There are basically two types of herb-drug interactions: one is
called pharmacokinetic interaction while the second one is pharmaco-
dynamic interaction. In the first type of interaction, the plant deterio-
rates the expected pharmacological potential of drug (antagonistic
effect) as a result of physiological and biochemical consequence on the
living body. While in pharmacokinetic interaction, the herb and drug
have the same pharmacological effect, which may produce an increased
therapeutic effect in coordination (synergistic effect). The antagonistic
interaction may be harmful if not checked for the efficacy and security.
The best example is crucial hypoglycemic being observed in a human
female suffered from diabetes, who has taken chlorpropamide and a
meal containing A. sativum and Memordica charantia L. (Izzo and
Ernst, 2001).
3.4. Traditional medical system and the role of Hakims
Survey conducted in the region has revealed a parallel coexistence
of allopathic medicines with traditional herbal remedies as mentioned
earlier. Most of the hakims are using Unani or Ayurvedic system of
traditional medication for the treatment of different diseases at local
level. Hakim is a person having better understanding about the
background of the patients and accordingly facilitates the disease
treatment process. The local herbalists usually diagnose any disease
through patient's symptoms and assessment of the pulse. The hakims
interviewed during the study were males, of whom very few were
qualified professionals. Remoteness of the respective area is the main
hurdle for the people to access modern medical facilities. The local
people indicated that consultation process with hakims mainly depend
on the personal experience of the practitioners.
3.5. Comparative analysis of the reported medicinal flora with
nearby regions of the country
A literature survey was conducted to analyze, assess and compare
the studied plant species with earlier reports. In total, 13 potential
studies were selected reporting the ethno-medicinal values of studied
medicinal plants in different mountainous regions of northwest and
southwest parts of the country (Qureshi et al., 2007; Akhtar et al.,
2013; Abbasi et al., 2013; Khan et al., 2013, 2014; Ullah et al., 2013;
Ahmad et al., 2014; Amjad and Arshad, 2014; Bano et al., 2014;
Arshad et al., 2014; Bibi et al., 2015; Ahmad and Pieroni, 2016; Sher
et al., 2016) (Tables 3, 4). Comparing our data with a study conducted
Khan et al. (2014) in the nearby territory, it was found that 17 species
were in common between the two studies. In another study conducted
in the South Waziristan agency by Ullah et al. (2013), we have found
only 9 species in common. Analyzing the overall data of 13 selected
studies, a total of 51 species out of 79 species were reported previously.
The remaining 28 species including Brassica cadmea Heldr. ex
M.A. Aziz et al.
Table 3
Comparative review of literature on the studied medicinal plants used by the mountainous communities across the county.
S. No. Previous study Location
1 Ahmad and Pieroni (2016) Sulaiman mountain range
2 Akhtar et al. (2013) Swat district
3 Ahmad et al. (2014) Swat district
4 Bibi et al. (2015) Swat district
5 Abbasi et al. (2013) Lesser Himalayas
6 Sher et al. (2016) Chitral District
7 Khan et al. (2013) Naran Valley, Western Himalaya
8 Qureshi et al. (2007) Bagh district
9 Amjad and Arshad (2014) Kotli District
10 Bano et al. (2014) Karakoram-Himalayan range
11 Ullah et al. (2013) South Waziristan agency
12 Khan et al. (2014) Hangu district
13 Arshad et al. (2014) Attock district
a
Shared species indicates how many plant species in the current study are common in comparison to the previous study.
O.E.Schulz, C. arvensis,, Calendula officinalis L., Celtis caucasica
Willd., Chenopodium murale (L.) S.Fuentes, Uotila & Borsch, Coix
lacryma-jobi L., Withiana somnifera L., Datisca cannabina L., Datura
metel L., Desmodium elegans DC., Grewia optiva J.R.Drumm. ex
Burret Eucalyptus camaldulensis Dehnh., Morella esculenta (Buch.-
Ham. ex D.Don) I.M.Turner, Origanum majorana L., Pistacia inte-
gerrima Stewart ex Brandis, Trachyspermum ammi (L.) Sprague,
Nigella sativa L., Ocimum basilicum L., Conyza canadensis (L.)
Cronquist, Quercus baloot Griff., Rumex crispus L., , Marubium
vulgare L., M. communis, M. piperita, S. esculentum, C. fistula, O.
littoralis, and V. indica were not reported in the previous studies. Most
of these plants are being traditionally used in folk medicines in other
parts of the country with the last two plant species not reported in
earlier ethno-medicinal study. For instance, root of C. fistula is
considered as astringent, purgative, as tonic and febrifuge. Root is
also used for rheumatism, hemorrhages, cardiac disorders, biliousness,
wounds, ulcers and skin diseases. Leave of the plant are crushed and
prepared a paste, and then mixed with the coconut oil, which is then
applied on burnt skin twice a day (Bhalerao and Kelkar, 2012).
Traditionally, T. ammi is being used as stomachic, carminative,
expectorant and antiseptic etc (Jeet et al., 2012). Similarly, O.
basilicum has stomachic, alexipharmic and antipyretic uses, and also
possesses diuretic and emmenagogue properties. Diuretic, aphrodisiac
and anti-dysenteric actions have also been ascribed to the seeds of this
plant. N. sativa is traditionally used as diuretic, diaphoretic, stomachic,
and liver tonic. A confection with other ingredients, the plant is used in
diarrhea, indigestion, and dyspepsia (Gilani et al., 2004). The pattern
of utilization of medicinal plants in a particular community is usually
exclusive and a part of its cultural traditional knowledge, passing from
one generation to another generation as a heritage. In the past, several
studies were about the uses of medicinal plants in a single culture or
one ethnic group while little attention been given to the comparative
studies of medicinal plant species in various communities (Heinrich
et al., 1998). However, in the last few decades, some researchers have
made their efforts to study the intercultural importance of medicinal
flora among different ethnic groups across the globe (Leonti et al.,
2006, 2009, 2010; Lardos and Heinrich, 2013; Gairola et al., 2014).
This comparisonal approach is practical and important to highlight the
significance, cross cultural variation, future research prospects on
medicinal plants.
3.6. Sustainable harvesting, commercialization and cultivation of
medicinal plants
The study area is much diversified with medicinal flora, however
the main problem is lack of awareness about the conservation of plant
resources. Similar to other ethno-medicinal studies reported from
different parts of the country (Sher and Barkworth, 2015; Sher et al.,
277
Journal of Ethnopharmacology 198 (2017) 268–281
Province Shared speciesa
Baloachistan 5
Khyber Pakhtunkhwa 12
Khyber Pakhtunkhwa 10
Khyber Pakhtunkhwa 0
Khyber Pakhtunkhwa 4
Khyber Pakhtunkhwa 16
Khyber Pakhtunkhwa 8
Azad Kashmir 4
Azad Kashmir 7
Gilgit-Baltistan 1
Khyber Pakhtunkhwa 7
Khyber Pakhtunkhwa 16
Punjab 14
2015a, 2015b, 2014, 2016), it was observed that there is an enormous
potential to improve the harvesting, storage, use, preparation and
marketing of the herbal product as a source of income. It was also
noted that different factors such as time of collection, processing,
storage and herbal preparations are important and necessary steps to
be considered. A study in Swat region of Pakistan has shown that
higher economic outcomes can be obtained from the harvesting of wild
medicinal plants as compared to the standard cash crop (Sher et al.,
2015b). It was also observed that only local healers are involved in the
collection of medicinal plants. They also supplement several medicinal
plants from the national markets. In the remote areas of the study
region, local inhabitants obtained significant economic advantages
from forest products. Similar advantages were found in different
mountainous communities of the northern parts of Pakistan that
depend on wild resources (Sher, 2002; Hamayun et al., 2003; Islam
et al., 2006; Shinwari et al., 2006; Ahmad et al., 2014;). Despite of all
these facts, natural resources of the area are under the threat of
extinction. Main reasons are heavy grazing pressure, deforestation,
uncontrolled collection of fodder and other non-timber forest products
by the local people, and traders (Sher and Barkworth, 2015). Several
other studies have reported decrease in the number of medicinal plants
due to over exploitation and environmental degradation (Hussain
et al., 2006; Larsen and Olsen, 2007; Sher and Barkworth, 2015). It
is therefore a dire need to manage and designed the overall grazing
system to encourage the sustainable regeneration and protection of
medicinal plants. Keeping the observation and findings of the current
investigation, proper management steps should be taken with the
active participation from the indigenous communities to conserve this
precious flora. It is also important to aware the local people about the
market value and sustainable harvesting of medicinal plant. Rapid
modernization and urbanization is not the only threat for plant species’
degradation but also pose a threat for the associated folk knowledge.
That is why that the disappearance of folk knowledge has been declared
more in danger than the natural resources themselves (Odora Hoppers,
2002; Dweba and Mearns, 2011). Therefore, we present a strong
recommendation that ethnobotany as a subject should be included into
the curriculum and help students to recognize the endangered and
medicinally important species of their respective regions. In addition,
incentives may be given to farmers for the cultivation of medicinal
plants on marginal lands and home gardens.
3.7. Conclusions and future recommendations
The study indicates that medicinal plants play a significant role in
the daily life of mountainous communities particularly in the northern
territories of the country. People are using these plants in their
traditional health system. Mostly the livelihood of the people in the
area depends on medicinal plants and other forest products collection.
M.A. Aziz et al. Journal of Ethnopharmacology 198 (2017) 268–281

Table 4
Presence and absence of the studied species in the context of previous literature. A (Ahmad and Pieroni, 2016); B (Akhtar et al., 2013); C (Ahmad et al., 2014); D (Bibi et al., 2015); E
(Abbasi et al., 2013); F (Sher et al., 2016); G (Khan et al., 2013); H (Qureshi et al., 2007); I (Amjad and Arshad, 2014); J (Bano et al., 2014); K (Ullah et al., 2013); L (Khan et al., 2014);
M (Arshad et al., 2014).

Plant species A B C D E F G H I J K L M Frequency Absolute

Acacia modesta Wall. 0 0 0 0 0 0 0 0 1 0 0 1 1 3 1

Acacia nilotica (L.) Delile 0 0 0 0 0 0 0 0 0 0 0 1 1 2 1
Achyranthes aspera L. 0 0 1 0 0 1 0 0 0 0 0 0 1 3 1
Acorus calamus L. 0 0 1 0 0 1 0 0 0 0 0 0 0 2 1
Ajuga integrifolia Buch.-Ham. ex D.Don 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1
Allium sativum L. 0 0 0 0 0 1 0 0 0 0 0 1 0 2 1
Artemisia absinthium L. 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1
Artemisia vulgaris L.. 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1
Berberis lycium Royle 0 1 0 0 0 1 0 1 1 0 0 0 0 4 1
Bergenia ciliata (Haw.) Sternb. 0 0 1 0 0 0 1 1 0 1 0 0 0 4 1
Brassica cadmea Heldr. ex O.E.Schulz 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Calendula arvensis (Vaill.) L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Calendula officinalis L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Calotropis procera (Aiton) Dryand. 0 0 1 0 0 0 0 0 0 0 0 0 1 2 1
Cannabis sativa L 0 1 0 0 0 0 0 0 0 0 0 1 1 3 1
Cassia fistula L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Cedrus deodara (Roxb. ex D.Don) G.Don 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1
Celtis caucasica Willd. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Chenopodiastrum murale (L.) S.Fuentes, Uotila & Borsch 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Coix lacryma-jobi L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Erigeron canadensis L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Coriandrum sativum L. 0 1 0 0 0 1 0 0 0 0 0 0 0 2 1
Cuscuta reflexa Roxb. 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1
Daphne mucronata Royle 0 1 0 0 0 1 0 0 0 0 0 0 0 2 1
Datisca cannabina L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Datura metel L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desmodium elegans DC. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dodonaea viscosa (L.) Jacq. 0 0 0 0 0 1 0 0 1 0 0 1 1 4 1
Duchesnea indica (Jacks.) Focke 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1
Dysphania botrys (L.) Mosyakin & Clemants. 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1
Equisetum arvense L. 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1
Eucalyptus camaldulensis Dehnh. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Euphorbia helioscopia L. 0 0 0 0 0 1 0 0 0 0 0 1 0 2 1
Euphorbia wallichii Hook.f. 0 1 0 0 0 0 1 0 0 0 0 0 2 1
Ficus carica L. 0 0 0 0 1 1 0 0 1 0 0 1 0 4 1
Foeniculum vulgare Mill. 0 1 0 0 0 1 0 0 0 0 0 1 0 3 1
Grewia optiva J.R.Drumm. ex Burret 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Indigofera heterantha Brandis 0 0 0 0 0 0 1 1 0 0 0 0 0 2 1
Isodon rugosus (Wall. ex Benth.) Codd 0 1 1 0 0 0 0 0 0 0 0 0 0 2 1
Juglans regia L. 0 1 0 0 0 1 1 0 0 0 0 0 0 3 1
Lotus corniculatus L. 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1
Mallotus philippensis (Lam.) Müll. Arg. 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1
Marubium vulgare L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Melia azedarach L. 0 0 1 0 0 0 0 0 0 0 0 1 1 3 1
Mentha longifolia (L.) Huds. 0 0 1 0 0 1 1 1 0 0 1 1 1 7 1
Mentha piperita L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morella esculenta (Buch.-Ham. ex D.Don) I.M.Turner 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morus nigra L. 0 0 0 0 0 0 0 0 0 0 1 1 1 3 1
Myrsine africana L. 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1
Myrtus communis L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nasturtium officinale W.T.Aiton 0 1 0 0 1 1 0 0 0 0 1 0 0 4 1
Nerium oleander L. 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1
Nigella sativa L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ocimum basilicum L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Olea ferruginea Wall. ex Aitch. 1 0 1 0 0 1 0 0 1 0 1 0 1 6 1
Opuntia littoralis (Engelm.) Cockerell 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Origanum majorana L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Paeonia emodi Royle 0 1 1 0 0 1 0 0 0 0 0 0 0 3 1
Peganum harmala L. 0 0 0 0 0 1 0 0 0 0 1 1 1 4 1
Pinus gerardiana Wall. ex D.Don 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1
Pistacia integerrima Stewart ex Brandis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Plantago ovata Forssk. 0 0 0 0 0 1 0 0 0 0 0 0 1 2 1
Platanus orientalis L. 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1
Punica granatum L. 1 1 0 0 0 1 0 0 1 0 0 1 0 5 1
Quercus baloot Griff. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ricinus communis L. 0 1 1 0 0 0 0 0 0 0 0 1 1 4 1
Rubus fruticosus auct. (L.) 0 0 0 0 0 0 0 1 1 0 0 0 0 2 1
Rumex crispus L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rumex hastatus D. Don 0 0 1 0 1 0 0 0 0 0 0 0 0 2 1
Solanum esculentum L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Solanum nigrum L. 0 1 0 1 1 0 0 0 0 1 0 1 5 1
Solanum virginianum L. 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1
(continued on next page)

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M.A. Aziz et al. Journal of Ethnopharmacology 198 (2017) 268–281

Table 4 (continued)

Plant species A B C D E F G H I J K L M Frequency Absolute

Trachyspermum ammi (L.) Sprague 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Viola indica W.Becker 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Withiana somnifera L. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Xanthium strumarium L. 0 1 0 0 0 0 0 0 0 0 1 0 0 2 1
Zanthoxylum armatum DC. 0 1 1 0 0 1 0 0 1 0 0 0 0 4 1
Ziziphus jujuba Mill. 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1
Ziziphus nummularia (Burm.f.) Wight & Arn. 0 0 0 0 0 0 0 0 0 0 1 1 1 3 1
5 17 13 0 4 21 9 5 9 1 9 17 16 51

Wild collection of the medicinal plants is very common and none of the
species is cultivated on farms. Many crude herbs are collected from
different hilly areas of the region and supplied to the national and
international markets.
In the study region, mostly the traditional knowledge is in the
custody of traditional herbalists and aged community members. The
knowledge is eliminating and eroding due to the lack of interest of
younger generation mainly due to modernization. The medicinal plants
of the study area are facing high conservation threat like other areas of
the country due to overexploitation, heavy grazing, deforestation and
forest fragmentation. Certain management steps are required for the
conservation of this precious flora while on the other side a thorough
campaign is needed for the safeguard of traditional folk knowledge.
These natural resources can be used to improve the socioeconomic
conditions of the local people.
Our comparative study shows that out of 79 studied plant species,
only 51 species were reported from other mountainous communities of
the country. In the current study, two plants namely O. littoralis, and
V. indica were reported in traditional herbal system for the first time.
These plant species requires a thorough investigation in the context of
phytopharmacological efficacy both in vitro and in vivo so as to
validate their biological potential. Further critical toxicological inves-
tigations are also required for the safe and secure use of such herbal
drugs. Moreover, it is highly recommended to authenticate the tradi-
tional herbal preparations and brought them under the control of
experienced herbal practitioners (Hakim).
In addition, plants have the capacity to absorb various types of
nutrients and elements from the soil. Some time soil toxic heavy metals
in higher concentration are taken up by the plant species through their
roots. The consumption of such plant material for medicinal and other
purposes may be threatened and it may produce various types of health
disorders. Therefore, it is imperative to validate the herbal products
with respect to heavy metal concentration in order to ensure the safe
and effective use of herbal products in future.
In conclusions, previous reports on the pharmacological (in vitro,
in vivo), phytochemical and toxicological aspects somehow support the
traditional uses of studied plants. However, a complete set of phyto-
pharmacological knowledge and clinical trials on the documented
plants is not available. Therefore, it is imperative to investigate each
plant species from the aforementioned perspectives in order to draw
general conclusions on the ethnopharmacological relationships, effi-
cacy and safe uses of traditional medicines.
Authors contribution
Amir Hasan Khan and Izat Ullah carried out field work.
Muhammad Abdul Aziz compiled the data and carried out the
statistical analysis. Amir Hasan Khan helps in Data compilation.
Muhammad Abdul Aziz and Muhammad Adnan prepared the draft
manuscript. Muhammad Adnan supervised all the stages of this
research and provided technical inputs. All the authors have read
and approved the final manuscript.
Competing interests
The authors have no conflict of interest.
Acknowledgement
The authors are thankful to the local community members and
herbalist who cooperate in the whole survey. The authors are also
grateful to Departmental colleagues for their moral support.
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