Professional Documents
Culture Documents
1 Es en
1 Es en
1 Es en
com
Cite this article as: Angel Josabad Alonso-Castro, Fabiola Domínguez, Juan
José Maldonado-Miranda, Luis Jesús Castillo-Pérez, Candy Carranza-Álvarez,
Eloy Solano, Mario Alberto Isiordia-Espinoza, María del Carmen Juárez-
Vázquez Juan Ramón Zapata- Morales, Marco Antonio Argueta-Fuertes, Alan
Joel Ruiz-Padilla, César Rogelio Solorio-Alvarado, Joceline Estefanía Rangel-
Velázquez Rolffy Ortiz-Andrade, Ignacio González-Sánchez, Gustavo Cruz-
Jiménez and Luis Manuel Orozco-Castellanos, Use of medicinal plants by
health professional in Mexico, Journal of Ethnopharmacology
http://dx.doi.org/10.1016/j.jep.2016.12.038
This is a PDF file of an unedited manuscript that has been accepted for publication.
As a service to our customers we are providing this early version or the manuscript.
The manuscript will undergo copyediting, typesetting, and review of the resulting
galley proof before it is published in its final citable form Please note that during
the production process errors may be discovered which could affect the content,
and all legal disclaimers that apply to the journal pertain
Use of medicinal plants by health professionals in Mexico
Luis Jesus Castillo-Pérez d, Candy Carranza-Álvarez c, Eloy Solano and, Mario Alberto
Marco Antonio Argueta-Fuertes h, Alan Joel Ruiz-Padilla to, César Rogelio Solorio-
Mexico
San Luis Potosí, San Luis Potosí, San Luis Potosí, Mexico
1
h Department of Biological Systems, Autonomous Metropolitan University Xochimilco unit,
angeljosabad@ugto.mx
angeljosabad@hotmail.com
*
Corresponding author: Angel Josabad Alonso-Castro; Address: Cerro de la Venada S / N,
Col. Pueblito de Rocha, CP 36040, Guanajuato, Gto. Telephone +52 473 732 0006 ext
5409
2
Abstract
Ethnopharmacological relevance:
The use of medicinal plants in Mexico has been documented since pre-Hispanic times.
remains to be explored.
To evaluate the use, acceptance and prescription of medicinal plants by health professionals
Direct and indirect interviews, regarding the use and acceptance of medicinal plants, with
from nine states in Mexico were performed from January 2015 to July 2016. The
interviews were analyzed with the factor the informant consensus (FIC).
Results:
The information obtained indicated that 46% of those interviewed feel patients should not
use medicinal plants as an alternative therapy. Moreover, 54% of health professionals, and
49% of the physicians have used medicinal plants as an alternative therapy for several
diseases. Twenty eight percent of health professionals, and 26% of the physicians, have
professionals were in agreement with receiving academic information regarding the use and
prescription of medicinal plants. A total of 77 plant species used for medicinal purposes,
belonging to 40 botanical families were reported by the interviewed. The results of the FIC
showed that the categories of diseases of the digestive system (FIC = 0.901) and diseases of
3
Conclusions:
This study shows that medicinal plants are used for primary health care in Mexico by health
professionals.
Abbreviations:
The Mexican Institute of Social Security (IMSS), 2) the Institute for Security and Social
Services for State Workers (ISSSTE), and 3) the Ministry of Health (SSA), the factor of
professionals
4
1. Introduction
Mexico is considered as one of the most biodiverse countries in the world. There are an
estimated 23 400 vascular plants in Mexico, of which 3000 have medicinal effects (Bye,
1993; Argueta et al., 1994; CONABIO, 2006). The use of medicinal plants in Mexico has
Mexican health authorities have shown interest in the research of medicinal plants and
the General Health Office published the Herbal Pharmacopeia in 2001 and 2013 (FHEUM,
2001; FHEUM, 2013). Nevertheless, only a small group of medicinal plants have been
studied for their pharmacological, phytochemical, and toxicological effects, as well as for
their pharmacokinetics. In 2012, 52.6% inhabitants were covered by public health insurance
(INEGI, 2012). This means that almost a half of the population have no access to a public
including medicinal plants, which are prescribed by “yerberos” or traditional healers (Casas
The use and acceptance of medicinal plants by the general population in Mexico has
been documented (eg Frei et al., 1998; Canales et al., 2005; Estrada et al., 2007; Robles-
Zepeda et al., 2011; Beltrán-Rodríguez et al., 2014). The acceptance and use of medicinal
plants by health professionals in Mexico has not yet been reported. Taddei-Bringas et al.,
(1999) carried out a survey in the state of Sonora (Northern Mexico) about the use and
carried out a study regarding the use and acceptance of phytomedicines by physicians in the
states of Morelos and Guerrero (Center of Mexico). The aim of this study was to evaluate
the use, acceptance and prescription of medicinal plants by health professionals in Mexico.
5
2. Methods
pharmacists, and odontologists) from the Mexican states of Baja California, Mexico City,
state of Mexico, Guanajuato, Jalisco, Nayarit, Puebla, San Luis Potosi, and Yucatan, were
performed from January 2015 to July 2016. A total of 1614 health professionals were
interviewed individually in private sectors and the three main public health institutions in
Mexico: 1) the Mexican Institute of Social Security (IMSS), 2) the Institute for Security
and Social Services for State Workers (ISSSTE), and 3) the Ministry of Health (SSA).
structured questionnaire. The inclusion criteria were health professionals: graduated with at
least one year of work experience, currently working in a private or public health institution
in Mexico. Health professional that were undertaking specialty training were also included
in this survey. There was no age restriction. Before beginning the interviews, the consent of
participation was obtained. The questions were regarding: the common and local name of
the plant used, medicinal use of plant species, preparation, and the plant parts used.
medicinal plants, and the agreement to receive academic information about the use and
prescription of medicinal plants were included in this survey. The validation of the survey
was performed with 100 people in Guanajuato city. The informants were requested to
provide a brief botanical description of the plant species that they mentioned. The
specimens indicated by the respondents were collected in different areas from Mexico,
6
Mexico (MEXU). The botanical names were corroborated at Missouri Botanical Garden-
The diseases treated with medicinal plants were grouped into 11 categories based on
the classification used by the International Classification of Diseases used by the World
The Factor of Informant Consensus (FIC), adapted by Heinrich et al. (1998), estimates
the level of agreement between interviewees about which plants to use for each category,
? ur -? t
FIC =
? ur - 1
Where nur is the number of citations of the medicinal plant in each category and nt is
the number of taxa or plant species that are used in each category. The result of this factor
the community and / or if that information is exchanged between informants, whereas a low
value indicates that plant species are chosen randomly, or that informants do not exchange
7
3. Results and discussion
The information obtained indicated that 46% of the interviewed, and 51% of the
physicians, feel patients should not use medicinal plants as an alternative therapy due to the
plants lack scientific evidence (n = 200), and c) are not safe (n = 197), among others. estos
trends found in Mexico and other countries range from 44.6% to 83% (Taddei-Bringas et
al., 1999; Romero-Cerecero et al., 2004; Fakeye and Onyemadu, 2008; Rodríguez-Torres et
al., 2013).
The results showed that 54% of health professionals, and 49% of the physicians, have
used medicinal plants as an alternative therapy for several diseases due to the following
reasons: their efficacy (n = 402), family tradition (n = 349), and to reduce the consumption of
allopathic medicine (n = 112). Our results are in agreement with other studies carried out in
Latin America, where the use of medicinal plants in traditional medicine is a common
practice (Clement et al., 2005; Oliveira et al., 2012). Twenty eight percent of health
professionals, and 26% of the physicians, have recommended / prescribed medicinal plants
to their patients. The trends found in Latin America ranges from 27% to 94.4% (Taddei-
Bringas et al., 1999; Romero-Cerecero et al., 2004; Clement et al., 2005; León-Espinosa et
al., 2008; Oliveira et al., 2012). The differences among these results rely on whether the
interviews were carried out in rural or urban areas. Health professionals who prescribe
medicinal plants took academic courses about herbal medicine after graduating.
Twenty nine percent of the respondents would replace the allopathic medications with
herbal remedies for the following reasons: a) in non-severe diseases (n = 200), b) because
herbal medicines are cheaper (n = 139), and c) due the safety and efficiency of medicinal
8
plants (n = 125). Traditional medicine in Mexico is the first alternative in health care
because many drugs for the treatment of gastrointestinal and respiratory diseases are
expensive or not available in rural areas, which may explain the trends we find herein. The
allopathic medicines.
information regarding the use and prescription of medicinal plants. Currently, health
professionals in Mexico do not receive information about traditional medicine during their
al., 2004; Romero-Cerecero et al., 2005; Romero-Cerecero et al., 2006; Oliveira et al.,
2012). Considering that a great proportion of the general population uses herbal medicine
as complementary and alternative medicine. These results clearly indicate the need to
incorporate courses regarding the use of medicinal plants among health professionals. The
prevention of potentially serious risks from misuse of some medicinal plants will be
reported. The medicinal plants were reported to treat 30 illnesses (Table 2). None of the
medicinal flora mentioned by the informants are endangered species. The most commonly
mentioned species were Matricaria recutita (n =117), Mentha spicata (n =51), Gnaphalium
(Table 2). The results indicated that 50% of plant species are reported to cure more than
one ailment and most of the folk remedies are administered in the form of infusions (Table
2). Our results are in agreement with other studies (Taddei-Bringas et al., 1999; Romero-
9
3.2 Factor of informant consensus
The results showed that diseases of the digestive system (FIC = 0.901), diseases of the
respiratory system (FIC = 0.898), and diseases of the musculoskeletal system and
connective tissue (FIC = 0.784) had the highest FIC values (Table 3). The findings show
that the main ailments treated by medicinal flora by health professionals in Mexico are
diseases of the respiratory and digestive systems, and there is also a consensus about the
plants to treat these ailments. This might be because most of these illnesses are acute and
It is essential to identify the risks associated to the consumption of medicinal plants and
establish a national program of pharmacovigilance. Clinical trials with the most frequent
medicinal plants used in this study are necessary to provide pharmacological and
toxicological evidence about their safe use in patients and health professionals. This study
indicates that the use of medicinal plants among health professionals in Mexico is common
practice.
AJAC designed research and wrote the paper. FD, JJMM, LJCP, ES, MAIE, MC JV, CCA,
JRZM, MAAF, AJRP, JERV, ROA, IGS, GCJ, and LMOC conducted the survey and
contributed to the analysis data. All authors read and approved the final manuscript.
Conflict of interest
10
Acknowledgments
The authors wish to thank the Directorate for Research Support and Postgraduate Programs
at the University of Guanajuato for their support in the editing of the English-language
eleven
References
Andrade-Cetto, A., 2009. Ethnobotanical study of the medicinal plants from Tlanchinol,
Argueta, A., Cano, A., Rodarate, ME, 1994. Atlas of Medicinal Plants of the
Traditional Mexican Medicine. Instituto Nacional Indigenista, Mexico, DF, pp. 1786
of the Sierra de Huautla Biosphere Reserve, Mexico. J. Ethnobiol. Ethnomed. 10, 1431.
Bennett, BC, Prance, GT, 2000. Introduced plants in the indigenous pharmacopoeia of
Bye Jr., R., 1993. The role of humans in the diversification of plants in Mexico. In:
Ramamorthy, TP, Bye, R., Lot A., Fa, J. (Eds.). Biological diversity of Mexico.
Canales, M., Hernández, T., Caballero, J., Romo de Vivar, A., Avila, G., Duran, A., Lira,
R., 2005. Informant consensus factor and antibacterial activity of the medicinal plants
used by the people of San Rafael Coxcatlán, Puebla, Mexico. J. Ethnopharmacol. 97,
429-439.
Canales, M., Hernández, T., Caballero, J., Romo de Vivar, A., Durán, A., Lira, R., 2006.
Rafael, Coxcatlán, Valle de Tehuacán – Cuicatlán, Puebla, Mexico. Minutes Bot. Mex. 75,
21–43.
Casas A, Valiente – Banuet, A., Viveros, J .L., Dávila, P., Lira, R., Caballero, J., Cortés, L.,
Rodríguez, I., 2001. Plant resources of the TehuacánValley, México. Econ. Bot. 55,
129-166.
12
Clement, YN, Williams, AF, Khan, K., Bernard, T., Bhola, S., Fortuné, M., Medupe, O.,
Nagee, K., Seaforth, CE, 2005. A gap between acceptance and knowledge of herbal
National Commission for the Knowledge and Use of Biodiversity (CONABIO), 2006.
Estrada, E., Villarreal, JA, Cantú, C., Cabral, I., Scott, L., Yen, C., 2007. Ethnobotany in
Ethnomed. 3, 8-15.
Fakeye, TO, Onyemadu, O., 2008. Evaluation of knowledge base of hospital pharmacists
92.
Frei, B., Baltisberger, M., Sticher, O., Heinrich, M., 1998. Medical ethnobotany of the
Heinrich, M., Ankli, A., Frei, B., Wiemann, C., Sticher, O., 1998. Medicinal plants in
Mexico: healer's consensus and cultural importance. Soc. Sci. Med. 47, 1859–1871.
ICD - International statistical classification of diseases and related health problems (World
Health Organization), 2007. 10th Revision. 2007. Web page at: http://www.who.int/
13
International Plant Names Index. 2008. Web page at: http://www.ipni.org (accessed May
2016).
Sierpe and Sancti Spíritus. Rev. Cubana Plant. Med. 13, 1-10
Oliveira, SG, de Moura, FR, Demarco, FF, Nascente, P. da S., Pino, FA, Lund, RG,
Basic Care Units in the Brazilian Unified Health System. J. Ethnopharmacol. 140,
428-437.
C., Navarro-Navarro, M., Contreras, LR, Corral, OL, Lozano-Taylor, J., 2011. Use
Rodríguez-Torres, E., Ortegón, EJ, Sandoval, IR, 2013. Knowledge of the staff of
14
Romero-Cerecero, O., Tortoriello, J., 2007. Knowledge about phytomedicines among
MB, 1999. Acceptance and use of therapeutic medical plants in family medical care.
Viesca, C., 1992. The libellus and its historical context. In: Kumate J (Ed.) Current studies
about him Libellus de medicinalibus indorum herbis. Secretary of Health, Mexico city,
fifteen
Table 1. Sociodemographic characteristics
16
Table 2 Plants species prescribed or recommended health personal in Mexico
17
Familia Scientific name Common Part Preparation / Ailment / symptoms Frequency of
Voucher yam used application individual
(Spanish) citations
Acanthaceae Spicigera justice Muicle, Leaves Infusion / oral Diabetes, 7
Schltdl FEZA 4656 mohuite immunostimulant
Amaranthaceae Amaranthus Amaranth Seeds Infusion / oral Diuretic, diarrhea 5
hypochondriacus L.
MEXU 1219
Amaryllidaceae Allium cepa L. Onion Bulb Raw Tuberculosis, cough 10
MEXU 128
Amphipterygium Cuachalalate Bark Infusion / oral Wound healing, 18
adstringens gastritis,
Anacardiaceae (Schltdl.) Standl. stomachache
FEZA 12900
Mangifera indica L. Mango Leaves Infusion / oral Cough 2
MEXU 2025
Schinus molle L. Pirul Leaves Infusion / Topical Cough 9
FEZA 7283
Apiaceae Eryngium carlinae Grass Whole Infusion / oral Urinary tract 9
F. Delaroche FEZA toad plant infection, diuretic,
13628 body pain
Foeniculum vulgare Fennel Whole Infusion / oral Cough, bronchitis 2
(L.) Mill FEZA plant
3919
Apocynaceae Nerium oleander L. Laurel Leaves Infusion / oral Gastritis 6
MEXU 254
Arecaceae Cocos nucifera L. Coconut Shell Infusion / Oral Diarrhea, vermifuge 3
MEXU 4451
Asphodelaceae Aloe vera (L.) Burm. Aloe Aerial Infusion / Oral Diabetes 7
F. MEXU 19481 parts
19
Cav. plant menstrual colic
MEXU 1395
Tanacetum Santa Maria Aerial Infusion / Oral Menstrual colic 5
parthenium (L.) Sch. parts
Beep. MEXU 2339
Bignoniaceae Tecoma stans (L.) Thunder Aerial Infusion / Oral Diabetes 7
Juss. ex Kunth parts
FEZA 13746
Buddlejaceae American Buddleja Hail royal Leaves Infusion / Oral Stomachache, 6
L. asthma
MEXU 7391
Cactaceae Opuntia ficus-indica Nopal Cladode Decoction / oral Diabetes 8
(L.) Mill. MEXU s
6445
Cannabaceae Cannabis sativa L. Marijuana Leaves Tincture / Topical Body pain 5
FEZA 7303
twenty
myriochaetum horse plant infection, diuretic,
Schltdl. & Cham. diabetes
FEZA 14994
Ericaceae Arctostaphylos Penguin Whole Infusion / Oral Urinary tract 6
pungens Kunth plant infection
FEZA 8328 Diuretic
Euphrobiaceae Cnidoscolus Chaya Leaves Infusion / Oral Urinary Diabetes 7
chayamansa tract infection
McVaugh FEZA
13972
Euphorbia Good night Whole Infusion / Oral Cough 1
pulcherrima Willd. plant
ex Klotzsch
MEXU 104
Fabaceae Medicago sativa L. Alfalfa Whole Maceration / Oral Diabetes 1
FEZA 7550 plant
twenty-one
Ocimum basilicum Basil Leaves Infusion / Oral Stomachache 5
L.
FEZA 13883
Rosmarinus Rosemary Whole Burn Body pain, 17
officinalis L. plant plant / Inhalation stomachache,
FEZA 5554 menstrual colic,
cough
Thymus vulgaris L. Thyme Whole Infusion / Oral Cough fifteen
L. FEZA 7829
Mexican tilia Tilia Flowers Infusion / Oral Nervousness 4
Schltdl. FEZA
13412
Myrtaceae Psidium guajava L. Guava Leaves Infusion / Oral Menstrual colic, 27
FEZA 13422 diarrhea,
Stomachache
Nyctaginaceae Bougainvillea Bougainvillea Leaves Infusion / Oral Asthma, cough fifteen
22
(Lam.) Brand s
MEXU 23984
Portulacaceae Portulaca oleracea Purslane Whole Infusion / Oral Vermifuge 2
L. MEXU 58 plant
Punicaceae Punica granatum L. grenade Fruit Infusion / Oral Diarrhea, headache 3
MEXU 346
Osbeck
MEXU QD131
Citrus paradisi Pink grapefruit Fruits Infusion / Oral Weight loss 2
Macfad MEXU
16868
Citrus sinensis (L.) Orange Shell Infusion / Oral Nervousness 1
Osbeck Fruit
MEXU 205
Chalepensis route L. Rue Whole Infusion / Oral Stomachache, 6
FEZA 13863 plant Infusion / Topical cough, body pain,
diarrhea
Saururaceae Anemopsis Grass Whole Decoction / topic Burns, wound 2
californica Hook. & meek plant l healing
Arn. MEXU 4582
Selaginellaceae Selaginella Doradilla Whole Infusion / Oral Diuretic 3
lepidophylla (Hook. plant
& Grev.) Spring
MEXU 003
2. 3
Verbenaceae Aloysia triphylla Kidron Leaves Infusion / Oral Diarrhea, vomiting, 8
Royle MEXU 1965 flu
Lippia Oregano Whole Infusion / Oral Cough, stomachache 2
berlandieri Schauer plant
MEXU 10688
Carolina verbena L. Verbena Whole Infusion / Oral Fever 2
FEZA 7261 plant
24
Table 3 Factor of informant consensus
25
Graphical abstract
26