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Ethnomedicinal knowledge on the precise use of herbal medicine An interview-based study on traditional healers from Jaunsar-Bawar region of Uttarakhand

Background : Jaunsar-Bawar region of Uttarakhand is well-known for its rich biodiversity. In continuation of our previous field survey on traditional medicinal plants used in diabetes mellitus, this study was designed to gather traditional knowledge about when and how the herbal remedies are used for different ailments by the tribal people. Methods : Information about the use of medicinal plants was collected from different folk healers of the region. The plant specimens were collected from their natural habitat and authenticated in the laboratory of Materia Medica and Taxonomy. Results : Out of the 200 plants, 41 species belonging to 27 families have been explored in this study based on their availability and potency. Most of the selected plants were found to be used topically while a few were suggested for oral use. These plants have been found effective in curing cuts, wounds, boils, bone fracture, muscular pain, inflammation, fever, mouth ulcer, stomach ache, headache and many other conditions. Conclusion : The study concludes that these plants have the potential to treat various health conditions. Exploration of these plants scientifically will be a great addition to the field of herbal medicine.


Background
According to the World Health Organization, the Traditional Health Care System is considered to be the best for curing diseases, and is used by 70% of the world population (WHO 2019). In many cases like chronic conditions, traditional medicine has proved its potential over modern biomedicine. Various research reports proved that synthetic drugs have many side effects both acute and chronic while herbal treatment is considered safe. Besides, herbal medication is comparatively cheaper than synthetic drugs, and hence, considered more economical for all. As a result, people from all over the world are again shifting back to herbal medicine due to economic and safe. Indian Traditional Systems of Medicine, such folk medicine and as the codified Ayurveda use monoherbal and polyherbal formulations that can be prepared by the patients themselves without depending on a practitioner ). The folk medicinal system of Uttarakhand uses a large variety of medicinal plants. To date, about 1500 folklore plants including Ayurvedic herbs have been reported in Uttarakhand with an area of 53,483 square kilometres. With varied agro-climatic region, Uttarakhand is rich in Medicinal and Aromatic Plants (MAPs) and is counted among the mega biodiversity regions of the world. Uttarakhand has a long history of folk medicines which are generally used for most of the ordinary ailments and mainly used by the tribal population of the region such as Jaunsari, Tharu, Raji, Buksa and Bhotiya tribes (Shah 1982). Likewise, the western hilly part of Nepal, an adjacent area to Uttarakhand state, is also known for its rich biodiversity and traditional knowledge. The climate of this area favours to growth of a variety of medicinal plants of industrial value that include Acacia catechu, Bacopa monnieri, Bombax ceiba, Drymaria diandra, Rauvolfia serpentina and Tribulus terrestris (Shrestha & Dhillion 2003;Singh et al. 2012;Adhikari et al. 2019).
The present study area Jaunsar-Bawar (Fig. 1), is situated in the Dehradun district of Uttarakhand and comprised of hill areas. This area lies in the border with Himachal Pradesh, with river Yamuna in the east and river Tons in the west, while Uttarkashi district is situated at its northern part. Kalsi, Sahiya, Chakrata, Debvan, Hanol, and Lakhamandal are among the most popular places in this region. In the past, many surveys have been conducted in different areas of the Uttarakhand state of India mainly in tribal areas (Joshi & Pant 2012;Sharma et al. 2013;Khajuria & Bisht 2017;Singh et al. 2019). However, the present study area is least explored for its folk medicine. The present study reports precise information about the doses, duration of the treatment and mode of administration of medicinal plants used in the folk medicine by the inhabitants of Jaunsar and Bawar areas of Uttarakhand for the first time.

Materials and methods
Field survey was conducted during the year between 2017 and 2020. A total of 8 visits of 3-5 days were conducted in the study area covering almost all the areas in different seasons included in our previous survey . The information about the local uses of these medicinal plants was collected from the local folk practitioners, cattle feeders and elder villagers. In this study, a total of 22 folk healers (17 male and 5 female) of 45-85 years of age were interviewed. The participants were identified by enquiring local people. A few healers having expertise in a specific disease, such as kidney stone, diabetes, hypertension and snakebite, were also interviewed. Practitioners who did not share the proper information about the medicinal use of the herbs were excluded from the study. Before the individual interview, verbal consent was taken from each participant and already informed them to publicise their experience-based knowledge globally for humankind. During the interview, photographs with all the participants were taken; selected pictures are given in Fig. 2.
Information was recorded in the standard questionnaire which included the local name of the medicinal plant, parts used, method of preparation, mode of administration, probable dosage and duration of treatment. As per the information, the plant samples were also collected from the study area to deposit their specimens to Uttarakhand Ayurved University (UAU) herbarium. The voucher specimen number of each plant is given in Table 1. The plant samples were identified with the help of local names given in the local floras published in previous years (Gaur 1999;Kanjilal 2011). Scientific authentication of the plants was done at the Research and Development Centre of UAU. The information about the medicinal plants during the field visit was cross-checked from the ancient Ayurvedic literature and scientific papers available online. A flow chart showing step-wise study design is given in Fig. 3.

Fig. 3.
Step-wise study design of the fieldwork

Results
The research revealed Jaunsar-Bawar region of Uttarakhand has a difficult geographical terrain and also lacks advanced medical facilities. Most of the people in this region are dependent on herbal medicines for their primary healthcare as they prefer higher medical centres only in serious conditions. The farmers, hunters, shepherds and grass cutters of this area are well-acquainted with the herbal remedies for primary healthcare and folk healers/ vaidyas are also consulted in cases of serious problems. The cattle feeders shared valuable information during the interview as their life is closely connected with the forested areas and plant wealth. They are mostly dependent on natural medicine when living in the forest region with their cattle. More than 200 plant species were recorded during the field survey, and based on information collected from the natives, 41 species were found to have therapeutical importance in the traditional medical system of this region. Based on the interview with local traditional healers and other elders, the information about herbal remedies is shown in Table 1. As the activity of a herb depends on its active constituents, selected bioactives found in these herbs are also given in Table 2.

Data analysis
Analysis of collected data on ethnomedicinal plants revealed that Leguminosae was the largest represented family with a total of five members whereas three members each were recorded for Apiaceae, Compositae, Lamiaceae and Ranunculaceae families (Fig. 4). Among them, a majority of plants (7) were found effective in fever, followed by bone-fracture/ joint pain (6) and cuts/ wounds (5) in which two plant species were found effective in more than one health conditions. The distribution of plants based on their uses against different medical conditions is shown in Fig. 5. Similarly, most of the plants used by traditional healers belong to herbs (23) that cover 56% of total plants, whereas the shrubs (9) cover only 22% (Fig.  6). Leaves (18) were the most used part in ethnomedicine followed by roots or underground parts (15). Moreover, topical route was recorded as the most accepted route for drug administration followed by the oral route. The pictures of selected medicinal plants are given in Fig. 7.   Five to ten fresh apical immature leaves are chewed for 5-10 minute for mouth ulcer and the leftover pulp in the mouth is spilt out. The treatment can be adopted 2 to 3 days once at any time.
An erect annual shrub of 1-3 m; leaf pointed trifoliate; flower yellow or red; pods green, several pods produced in clusters; seeds 3-5 per pod.

Discussion
The results of the present study revealed that cuts, wounds, boils, bone-fracture, joint pain, fungal infection, cough, cold, asthma, mouth ulcer, headache, jaundice, muscular pain, swelling, kidney stone, toothache, fever, snakebite, intestinal parasites, eyes related problems and stomachache are the main health conditions treated by the folk healers with the help of herbal medicine. Most of the above health conditions are associated with acute pain and inflammation and require emergency management (Abdolrazaghnejad et al. 2018). Hence, the traditional knowledge of healers of these rural areas is playing a key role in the primary healthcare of a large population using natural remedies. Moreover, herbal remedies are the best choice of treatment due to their high efficacy with no serious side effects.
It has been noticed that most of the ethnomedicinal herbs were used topically mainly for the treatment of cuts, wounds and bone fractures. However, the oral application of selected herbs was recorded for a few health conditions including stomachache and intestinal worms. Although the oral administration of a drug is most accepted, the topical route has many advantages over due to its easy application at a selective site and minimum side effects (Sharadha et al. 2020). Hence, it can be considered safe to use an herbal remedy via a topical route even without consulting a practitioner.
The results of the present field survey were found encouraging as many plants species were explored for their traditional uses for the first time. The present work can be considered as an extension of the field surveys conducted earlier by various researchers. Previous studies on the ethnobotanical survey of medicinal plants of other areas of Uttarakhand shows that the Gujjar tribe of Sub-Himalayan tract uses leaf or root of Vitex negundo, Withania somnifera and Senna tora for boils, leaf or stem bark of Dalbergia sissoo for eczema and fruits of Abrus precatorius and Plumbago zeylanica for leucoderma (Sharma et al. 2013). On the other hand, in the Siwalik region, inhabitants use Adhatoda vasica for rheumatism, cough and intestinal worms, Achyranthes aspera for skin diseases and colic conditions while Carissa opaca and Quirivelia frutescens were used for fever, skin disease and toothache (Gaur & Sharma 2011). The field studies on the Pauri region revealed that the bark of Acacia catechu is used for waist pain, leaves of Adhatoda vasica with Piper nigrum for bronchitis and tuberculosis, roots of Boerhaavia diffusa with ghee for redness of the eyes, the leaf powder of Adiantum capillus-veneris for menstruation problems, juice of Chenopodium album for urinary problems whereas fruit or seed powder of Rubus niveus, leaves of Ocimum basilicum and Cynodon dactylon are used for calculi by the natives (Dangwal & Sharma 2011;Khajuria & Bisht 2017). Traditional healers of this region also used the seed oil of Madhuca longifolia for bodyache, leaf paste of Delphinium denudatum for burns and leaf paste of Cyperus rotundus for the treatment of skin ailments (Pandey & Pandey 2010). Apart from common ailments, the inhabitants also used various plants for psychomedicinal purposes that include Stephania glabra, Betula utili and Prunus cerasoides (Tiwari et al. 2010).
Ethnobotanical field surveys play a key role in the new drug discovery from natural products (Albuquerque et al. 2014). Such studies are not limited to a certain region but extensively conducted worldwide viz. Asia (Xiong et al. 2020), Africa (Van Wyk et al. 2008), America (Botsaris 2007), Europe (Pieroni et al. 2013) and Australia (Thompson et al. 2019). To date, several medicinal products have been developed from natural sources and used extensively across the globe. Still, there are many remote areas having rich plant diversity, that are unexplored, the ethnobotanical survey of such areas may help find a solution to different untreatable chronic diseases including cancers.

Conclusions
The present survey-based study revealed that a major part of Jaunsar-Bawar region of Uttarakhand is remote in location. The rural population of this region still depends on folk medicine due to limited access to advanced medical facilities. Although in the nearby towns hospital facilities are also available, many people cannot afford the costly treatment. Hence, the folk knowledge of herbal remedies is no less than a boon for the inhabitants of this region. Interestingly, these plants are effective in treating various ailments without showing any adverse effect as being practised for centuries. However, their scientific validation with the proper mode of action is necessary to develop them as a medicine for commercial use.