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Ethnomedicinal Practices and Traditional Medicinal Plants of Barak Valley, Assam: a systematic review

Objectives The Barak Valley is well known for its rich diversity of medicinal plants. Ethnomedicinal practices are prominent among Barak Valley’s major and minor ethnic groups. This systemic review focuses on traditionally used medicinal plants found in the Barak Valley as reported in different ethnobotanical surveys. Methods We searched various databases, including PubMed, Web of Science, and Google Scholar, to find ethnomedicinal surveys conducted in the Barak Valley. The search was performed using different terms, including ethnomedicinal survey, folk medicine, indigenous knowledge, and Barak Valley. Potential articles were identified following the exclusion and inclusion criteria. Results A total of eight ethnobotanical surveys were included in this study. We identified a total of 216 plant species belonging to 167 genera and 87 families, which are widely used by the ethnic communities who live in the rural areas of Barak Valley for the treatment of various diseases and ailments. Conclusion Folk medicine is the result of decades of accumulated knowledge and practices by people who live in rural communities based on their needs and provides an important source of information to assist the search for new pharmaceuticals. Therefore, available information on traditional medicinal plants needs to be explored scientifically to find effective and alternative treatments for different diseases.


INTRODUCTION
The Barak Valley, located between 24°8' and 25°8'N, 92°15' and 93°15'E, is comprised of three districts of Assam; Cachar, Hailakandi, and Karimganj. This area is located in the Southern part of Northeast India and covers an area of 6,922 km 2 . Considering the physiography of the area, Barak Valley can be divided into different ecosystems, ranging from the high hills, whose elevation exceeds 300 meters, to the perennially water-logged wetlands. The Valley reports a warm, humid climate with an average annual rainfall of 2,440-4,100 mm, most of which is acquired during the southwest monsoon season spanning May to September [1]. A well-known feature of the Barak Valley is the rich diversity of medicinal plants found along the wetlands and floodplains, which are home to several tribes and other communities [2].
The Cachar district covers an area of 3,786 km 2 and has a population density of 17,360, as per the census of 2011. There are many small rivers in the district flowing from Manipur or Mizoram. The main river is the Barak, from which the name Barak Valley is derived. The district's forests are the Barail and Inner line reserves. The Hailakandi district covers an area of 1,327 km 2 with a population size of 6,59,296 per the 2011 census. The Dhaleswari river is the main river of the district and flows north through the center of the district. The Inner line reserved forest and the Katakhal reserved forest make up the district's reserves. The Kamriganj district has a geographical area of 1,809 km 2 and a population of 12,28,686 as per the census of 2011. The Kushiyara river runs through the Kamriganj district on the district's northern border with Bangladesh [1].
Humans have used plants to cure diseases and relieve physical agony since before recorded history [5]. Plants have been used as medicinal agents initially based on anecdotal evidence and then later developed into single-agent drugs via scientific methods [6]. Science and technology have experienced significant advances since the turn of the century. Plants used as folk medicines have helped identify plants to further scientifically investigate, reducing the time for new drug discoveries. Still, much of the population living in remote areas rely on herbal medicine as their primary means of healthcare [7].
There are many ethnic groups in India with diverse backgrounds, and it has been reported that approximately 400 tribes and ethnic groups make up India's rural population. Most of India's tribes and ethnic groups reside in rural areas and forests and rely heavily on the indigenous system of medicine. The World Health Organization (WHO) emphasizes the use of plants by different ethnic groups around the world [8,9]. Therefore, this paper focuses on a systematic documentation of ethnomedicinal practices, and folk use of medicinal plants in Barak Valley, Assam.

Data sources and search strategy
Using ethnobotanical surveys, this review compiled medicinal plants traditionally used in medicine. This study was performed following the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) [10].
Discerning pertinent articles for this study was done while focusing on the main objectives of this systematic review. Google Scholar, PubMed, Springer, and Scopus databases were searched to locate relevant literature. The search was filtered without regard to duration or publication date and was last updated on January 31 st , 2022.
Specific keyword combinations included "ethnomedicinal survey" OR "ethnobotanical uses" OR "folk medicine" OR "eth-nobotanical survey" OR "indigenous knowledge" OR "traditional knowledge" AND "medicinal plants" OR "Barak Valley" OR "Specific state of Barak Valley" as well as free-text words were used in the search.

Inclusion and exclusion criteria
Ethnomedicinal studies and surveys that reported plants used traditionally in treating various diseases were included in this review. The inclusion criteria for the articles were fulllength research articles published in English and ethnobotanical surveys conducted in the Barak Valley region of Assam. The exclusion criteria included articles published in other languages, review articles, articles on ethnoveterinary use, and articles published in platforms or forums other than scientific journals.

Data selection
In the first phase of article selections, a manual evaluation of journal article titles and abstracts was performed by four different authors to include the articles related to the topic. All potentially qualified papers were examined again by other authors. A third author's opinion was considered in cases of discrepancies. The data selection process is given in Fig. 1.

Data analysis and reporting
A detailed evaluation of the literature search data was conducted, and data, including the plant name, family, local name or vernacular name, parts used, reported traditional uses, detail of informants, and area of the survey was epitomized. Based on the scope of this systematic review, no specific analytical tools were used.
In the ethnobotanical surveys across the Barak Valley, most of the information and data was collected through traditional Records identified from Journal articles (n = 180) Books/Book chapters (n = 1) Magazines/Reports (n = 4) Duplicate records removed (n = 46) Records marked as ineligible (n = 39) Records removed (other than journals) (n = 5) Records screened (n = 95) Papers excluded manually: Non original article/review article (n = 46) Paper other than English language (n = 1) Reports sought for retrieval (n = 48) Article not retrieved/full length article not found (n = 3) Reports assessed for eligibility (n = 45)

DISCUSSION
It is estimated that a large proportion of the global population still relies on herbal medicines for their primary health care needs. People have always used plants as a source of medicine to cure various ailments. Our ancestors learned to utilize different plants for medical purposes through trial and error, and the knowledge has been passed from generation to generation without any written script. This knowledge of plants is still used in rural and ethnic communities [15,16]. Ethnomedicinal and ethnobotanical surveys remain an important approach to   finding unexplored plant resources that can be an important source for new drug discoveries [15]. Indigenous people have utilized many plants for medicinal purposes to maintain their health. There are countless possibilities for new drugs based on folk uses of plants [17]. It is estimated that only 5-15% of higher plant species (about 250,000 species) have been scientifically explored [16]. In India, folk medicine plays an important role in rural areas. It is estimated that traditional medicine use 8,000 plant species and more than 25,000 herbal formulas [18].  [19], Borthakur (1997Borthakur ( , 2004 [20,21], Bhattacharjee et al. (1980) [22], Dutta and Dutta (2001) [23] also highlighted the importance of medicinal plants of this area and our observations are also in the line of such documents. Expansion of modern civilization has a huge impact on the practice of traditional knowledge, most primitive civilizations have abandoned their cultural and traditional beliefs and traditions. There will be a gradual separation from culture and tradition, resulting in the loss of plant knowledge and practices in daily life. As a result, there is an urgent need to record such information for the benefit of mankind as a whole, before these people entirely lose their knowledge of the therapeutic benefits of plants.
This systematic review identified only eight ethnobotanical surveys, which is small considering the area, diversity of medicinal plants, and nature of the indigenous people. However, this review depicted the medicinal value of 216 plant species. Ethnobotany, scientific investigations focusing on the observations of ethnobotanical surveys, and validations of ethnomedicinal claims are important in identifying possible targets for new drug discoveries.

CONCLUSION
In the Barak Valley region, ethnomedicine is prevalent, and the people have a deep understanding of how plants can be used for different ailments. Furthermore, the Barak Valley contains a large number of plants used to treat ailments in the daily lives of the people in this region, whose potential has not yet been scientifically investigated. This paper provides significant data on the diversity, indigenous knowledge, and folk medicinal value of medicinal plants. This data is important for discovering of new pharmaceuticals based on plants used in traditional medicine in the Barak Valley.