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Medicinal plants used by women in Mecca: urban, Muslim and gendered knowledge

Journal of Ethnobiology and Ethnomedicine201713:62

https://doi.org/10.1186/s13002-017-0193-4

Received: 26 June 2017

Accepted: 27 October 2017

Published: 17 November 2017

Abstract

Background

This study explores medicinal plant knowledge and use among Muslim women in the city of Mecca, Saudi Arabia. Ethnobotanical research in the region has focused on rural populations and male herbal healers in cities, and based on these few studies, it is suggested that medicinal plant knowledge may be eroding. Here, we document lay, female knowledge of medicinal plants in an urban centre, interpreting findings in the light of the growing field of urban ethnobotany and gendered knowledge and in an Islamic context.

Methods

Free-listing, structured and semi-structured interviews were used to document the extent of medicinal plant knowledge among 32 Meccan women. Vernacular names, modes of preparation and application, intended therapeutic use and emic toxicological remarks were recorded. Women were asked where they learnt about medicinal plants and if and when they preferred using medicinal plants over biomedical resources. Prior informed consent was always obtained. We compared the list of medicinal plants used by these Meccan women with medicinal plants previously documented in published literature.

Results

One hundred eighteen vernacular names were collected, corresponding to approximately 110 plants, including one algae. Of these, 95 were identified at the species level and 39 (41%) had not been previously cited in Saudi Arabian medicinal plant literature. Almost one half of the plants cited are food and flavouring plants. Meccan women interviewed learn about medicinal plants from their social network, mass media and written sources, and combine biomedical and medicinal plant health care. However, younger women more often prefer biomedical resources and learn from written sources and mass media.

Conclusions

The fairly small number of interviews conducted in this study was sufficient to reveal the singular body of medicinal plant knowledge held by women in Mecca and applied to treat common ailments. Plant availability in local shops and markets and inclusion in religious texts seem to shape the botanical diversity used by the Meccan women interviewed, and the use of foods and spices medicinally could be a global feature of urban ethnobotany. Ethnobotanical knowledge among women in Islamic communities may be changing due to access to mass media and biomedicine. We recognise the lack of documentation of the diversity of medicinal plant knowledge in the Arabian Peninsula and an opportunity to better understand gendered urban and rural knowledge.

Keywords

EthnobotanySaudi ArabiaIslamTransmissionFood-medicine continuum

Background

The use of medicinal plants in urban environments

Currently, more people live in cities than in rural areas, and urban populations continue to grow: by 2050, two thirds of the world’s population will live in cities [1]. Urbanisation brings new health challenges resulting from ease of contagion, maintenance of disease due to high population densities and stress-related ailments [2]. Although biomedicine is often easily available in urban settings, traditional medicines can still be the most convenient and affordable health care resource [2, 3]. Similar to people in rural areas, urban dwellers can hold rich medicinal plant knowledge. Recent studies evidence the dynamism and adaptive nature of urban medicinal plant knowledge (e.g. [37]), challenging views that such knowledge is lost in cities.

Since Balick et al. [4] noted a lack of ethnobotanical studies in urban areas, urban ethnobotany has flourished. Ethnobotanical surveys in cities have focused on issues such as the change of plant use by international immigrants [4, 6, 812] or the ethnobotanical diversity found in urban and peri-urban markets [1315] and home gardens [16, 17]. With few exceptions [7, 14, 15], these studies are set in Northern and Western countries. Cities in other parts of the world are equally dynamic plant knowledge hubs, and some have played an important role in the trade of medicinal plant material and knowledge historically. This is the case of cities along the silk and incense trade routes in the Middle East [1820].

Women’s medicinal plant knowledge

Several studies across the world have reported the pivotal role of women as holders of medicinal plant knowledge [2128]. Medicinal plant knowledge is often women’s cultural domain because of the role women play in providing household care [2123, 29, 30]. It also stems from gendered labour and spaces, which affect plant resource harvesting and management [21, 22, 26]. Women are often more knowledgeable about medicinal plant identification and use than are men [21, 2325], and their knowledge can be epistemologically different [22].

Moreover, the documentation of traditional knowledge as part of plant biodiversity research has historically been gender-biased towards men, which can result in misleading and incomplete results [22, 31, 32]. Both Howard [22] and Pfeiffer and Butz [32] claim that focus on male specialists, such as shamans and herbalists, has ignored a wealth of lay, female plant knowledge in ethnobotanical research. Historically, ethnobotanists have been predominantly male, which hampered their access to women’s knowledge in societies where men are granted greater public access than women [32]. These considerations are particularly important in conducting ethnobotanical research in the Islamic world, where gendered spaces and networks are particularly strong. Women in urban Islamic contexts have so far gone unnoticed by ethnobotanical enquiry, although they are the main medicinal plant users in Saudi Arabian cities [33].

Islam and medicinal plants

In the Arabian Peninsula, where this study took place, the use of local plant diversity for medicines is part of the cultural heritage [34, 35] and is currently embedded in Islamic medicinal practices. Islamic medicine integrates ancient Greek medicine, which first arrived to the Islamic world through translations of the works of Hippocrates, Dioscorides and Galen [36], with the teachings of the Prophet Mohamed (Hadith) referring to health, disease and medical treatment that became known as ‘The Medicine of the Prophet’ [37, 38]. From ancient Greek medicine, understandings of the functioning of the body through the humoral system and the view of disease as a loss of balance became part of Islamic medicine [37, 39, 40]. Arabian physicians, such as Al Razi, Ibn Sina, Aby Al Kassin Al Zahrawi, Ibn Rushd and Ibn Naffs, further developed medicine as a scientific discipline in the Middle Ages [36].

Islamic religious practices generate specific cultural behaviours that aim to preserve health, and early Islamic medical tradition focused on preventive rather than therapeutic medicine [3739]. Beliefs in jinni and Evil Eye as causes of illness are also common in the Arab world [29, 36, 40]. These magical features are possibly elements of the Bedouin world view that became legitimised by the Quran and the Hadith [40]. Stemming from religious teachings, Islamic medicine has a holistic view of health, where physical, spiritual, psychological, social and environmental factors are intertwined [38, 39]. The maintenance of health and recovery from illness are both a physical and spiritual process, underpinned by the belief in God [38, 39].

Study aims

Whilst medicinal plant uses are under-documented in the Middle East [41, 42] and a trend of loss of ethnobotanical and ethnomedicinal knowledge is observed in this area [36, 43], the extent of medicinal plant knowledge held by urban women remains unknown. The aim of this study was to document urban women’s medicinal plant knowledge in an Islamic context, identifying the plant species used. Additionally, modes of transmission of knowledge were evaluated, evidence for change noted. The extent to which women’s medicinal plant knowledge has been under-documented was inferred by comparing results from free-listing and semi-structured interviews conducted with women in Mecca to selected published literature on medicinal plants used in Saudi Arabia.

Methods

Research setting: Mecca as a study site

The city of Mecca (Kingdom of Saudi Arabia) is located in a narrow valley 80 km south of Jeddah on the Red Sea coast, west of the Arabian Peninsula (Fig. 1). The city is the capital of the Mecca region, neighbouring the regions of Medina in the north, Baha and Asir in the south and Al-Riyad in the east. The region of Mecca is situated in a subtropical dry environment [44]; its vegetation is dominated by xerophytic species and composed of floristic elements from the Saharo-Arabian, Irano-Turanian and Sudano-Zambian biogeographical regions [45].
Fig. 1

Map of Saudi Arabia with regional divisions. The city of Mecca is indicated by a dot

Mecca was the birthplace of the Prophet Muhammad and the site of the first Quranic revelation. It is regarded as the most holy city in Islam and the pilgrimage to Mecca, known as Hajj, is obligatory for all able Muslims. Due to the high numbers of pilgrims travelling to Mecca, the city is the most culturally diverse in the Islamic world. Saudi Arabians may use both traditional herbal and biomedical treatments [34, 36, 45], and a wide range of health care resources are available in Mecca: from traditional medicines and healers ([45], Al-Qethami, pers. obs), to modern biomedical care provided by the Saudi government for free to all Muslims.

Conducting interviews with Meccan women

The ethical guidelines of the Code of Ethics of the International Society of Ethnobiology [46], the Declaration of Helsinki [47] and University of Reading ethical protocols were followed in this research. Approval from the Ethics Committee of the School of Biological Sciences, University of Reading, was obtained (Research Ethics Project Submission SBS15-16 11).

Meccan women were interviewed by the first author from May to June 2016; individual free-listing and semi-structured interviews were conducted with 32 female adults. Targeted sampling was used for selecting informants who use medicinal plants [48] from the first author’s social network. Snowball sampling was later used to identify other local women who use medicinal plants [49]. All the informants were born in the Mecca region, with ages ranging between 28 and 69 years old (see Table 1 for the informants’ anonymous social data). Although older informants may hold further knowledge, interviews were conducted until a saturation of information was reached. Prior informed consent was obtained verbally from each woman before they were interviewed. Interviews were conducted in Arabic and recorded when the agreement from the informants was obtained (n = 9). Firstly, women were asked to list the medicinal plants they knew, documenting plant names. Then, semi-structured interviews were used to elucidate the parts used, therapeutic uses, preparation and administration processes (including use in mixtures) and perceptions of potential toxicity and side effects of plants used. Moreover, women were asked about how they had acquired this knowledge, if medicinal plants or biomedicine were preferred and when medicinal plants where preferred over biomedicine. The resulting ethnographic data were useful to understand women’s attitudes, beliefs and therapeutic goals underpinning medicinal plant use.
Table 1

Informant’s details. Place of residence is at the time of the interview; three women were temporarily living in the UK, where they were interviewed. MP/BM refers to preference for medicinal plants or biomedicine

Code

Age

Occupation

Literacy

N of children

Place of residence

N of household members

Place of origin

Number of plants listed

MP/BM

Source knowledge

inf1

30

Lecturer

PhD (Arabic, English)

1

Reading, UK

3

Mecca

15

BM

Scientific lectures, grandparents and mother

inf2

47

Lecturer

PhD (Arabic, English)

6

Reading, UK

8

Jeddah

13

MP

Grandmothers and mother

inf3

35

Housewife

Secondary education (Arabic)

5

Mecca

7

Mecca

9

BM

Grandmothers and mother

inf4

31

Student

PhD (Arabic, English)

0

Reading, UK

9

Mecca

10

BM

Mother, scientific lectures, Internet

inf5

49

Housewife

Primary education (Arabic)

6

Mecca

8

Mecca

23

MP

Mother

inf6

51

Housewife

Primary education (Arabic)

3

Mecca

4

Mecca

18

MP

Grandmothers

inf7

32

Housewife

Secondary education (Arabic)

5

Mecca

7

Mecca

21

MP

Grandmothers, mother, neighbours, books, Internet, television

inf8

49

Housewife

Primary education (Arabic)

5

Mecca

6

Mecca

13

MP

Grandmothers

inf9

50

Housewife

Primary education (Arabic)

4

Mecca

5

Mecca

24

MP

Written sources, mother and aunt

inf10

60

Housewife

Primary education (Arabic)

10

Mecca

5

Mecca

18

MP

Grandmothers

inf11

45

Housewife

Primary education (Arabic)

2

Mecca

3

Mecca

24

MP

Grandmothers

inf12

56

Housewife

Primary education (Arabic)

2

Mecca

4

Mecca

24

MP

Grandmothers

inf13

32

Housewife

Bachelor (Arabic)

4

Mecca

6

Mecca

9

BM

Mother

inf14

65

Housewife

Illiterate (Arabic)

9

Mecca

10

Mecca

12

MP

Grandmothers

inf15

34

Housewife

Secondary education (Arabic)

2

Mecca

4

Mecca

12

BM

Wider community (social network beyond family members)

inf16

29

Housewife

Bachelor (Arabic)

3

Mecca

5

Mecca

15

BM

Mother, Internet

inf17

69

Housewife

Illiterate (Arabic)

7

Mecca

9

Mecca

17

MP

Grandmothers

inf18

60

Housewife

Illiterate (Arabic)

9

Mecca

6

Mecca

25

MP

Mother, Internet, shops of medicinal plants

inf19

30

Housewife

Bachelor (Arabic)

3

Mecca

5

Mecca

8

BM

Mother, Internet

inf20

59

Housewife

Primary education (Arabic)

3

Mecca

4

Mecca

18

MP

Grandmothers

inf21

50

Housewife

Illiterate (Arabic)

6

Mecca

8

Mecca

17

MP

Grandmothers

inf22

45

Housewife

Bachelor (Arabic)

6

Mecca

8

Mecca

16

MP

Grandmothers

inf23

37

Housewife

Secondary education (Arabic)

5

Mecca

7

Taif

12

MP

Grandmothers

inf24

39

Housewife

Bachelor (Arabic)

4

Mecca

6

Mecca

17

MP

Grandmothers

inf25

34

Housewife

Bachelor (Arabic)

3

Mecca

5

Mecca

12

BM

Mother

inf26

33

Housewife

Bachelor (Arabic)

3

Mecca

5

Mecca

12

BM

Family

inf27

33

Housewife

Bachelor (Arabic)

4

Mecca

6

Mecca

24

MP

Family, nutrition studies at the university

inf28

34

Housewife

Bachelor (Arabic)

6

Mecca

8

Mecca

17

BM

Mother, family, friends, Internet

inf29

28

Lecturer

Bachelor (Arabic)

1

Mecca

3

Mecca

18

BM

Mother, sisters, school

inf30

46

Housewife

Bachelor (Arabic)

4

Mecca

6

Mecca

17

MP

Mother, family, books

inf31

60

Housewife

Primary education (Arabic)

9

Mecca

5

Mecca

12

MP

Grandmothers

inf32

60

Housewife

Illiterate (Arabic)

10

Mecca

5

Mecca

10

MP

Grandmothers

Analysis of medicinal plant’s salience

Data collected during interviews were structured in ‘use reports’. A ‘use report’ is one citation of one plant use by one informant, and it includes vernacular name, part used, local use, preparation and administration. Alongside the emic use citations, therapeutic applications were classified by disease categories according to the International Classification of Primary Care, as recommended by Staub et al. [50]. The software anthropac [51] was used to analyse free-lists, obtaining the frequency of citation and Smith’s index for each plant [52]. Smith’s index is a measure of the cultural importance of each plant depending on the frequency of citation and its rank in the free-lists [52].

Plant collection and identification

Most voucher specimens were obtained directly from informants. When this was not possible, they were obtained from local shops and supermarkets (Atar AlKuwait, Atar Alamana and Matager Alsudia; Fig. 2). Voucher specimens were not obtained for two plants; specimens from the Umm Al-Qura University herbarium were used to identify these according to vernacular names. Voucher specimens (including market samples) were deposited in the Umm Al-Qura University herbarium. Since no plants were collected from the wild directly, collection permits were not necessary. Plant identification was carried out by the first author in the herbarium of Umm Al-Qura University using the Flora of Saudi Arabia [53], and identifications were validated by a plant taxonomist in Umm Al-Qura University. Nomenclature and family adscriptions follow The Plant List [54], and the list was contrasted with the online checklist of the Flora of Saudi Arabia [55].
Fig. 2

Herbalist store in Mecca. Atar AlKuwait, one of the most famous establishments selling medicinal plant products in Mecca

Literature review

In order to assess the documented Saudi Arabian medicinal plant knowledge, a systematic literature review was conducted. Google Scholar, the Saudi Digital Library, Research Gate and King Abdullah bin Abdulaziz Library were searched for books and scientific articles using the search terms ‘Saudi Arabia’, ‘Mecca’, ‘Medicinal Plant’, ‘Herbal’, ‘Traditional Medicine’ or ‘Ethnobotany’ in English and Arabic, with no restriction on date of publication. Literature were excluded if they only reported pharmacological activities without mention of local knowledge sources, or if they focused on veterinary plant uses. Eleven sources were identified, obtained and reviewed, including seven journal articles and four books. For these, the methods were reviewed, examining how local names and plant uses were recorded and how plant identification was achieved. Explicit knowledge documentation methods, collection of herbarium specimens, the literature used to identify them and deposition in herbaria were quality criteria used to identify rigorous literature sources [5, 56]. One book and three scientific articles were considered rigorous and selected to compare the medicinal plants listed with those used by the women in Mecca interviewed during this study. The names from selected literature were cross-checked with The Plant List [54] to identify accepted plant names and family assignments. Botanical species, vernacular names and uses mentioned by women in Mecca during the field study were then compared to those in the selected literature to identify the extent of the overlap between lists.

Results

Medicinal plants used by women in Mecca

In total, 753 use reports were collected during interviews and 118 medicinal plant vernacular names were documented, belonging to approximately 110 botanical taxa (43 families; Table 2), including one algae (Fucus vesiculosus). Ninety-five medicinal plants were identified at the species level, 12 were identified at the genus level, one at the family level and two could not be identified. The most common medicinal families are Apiaceae (10%; 11 taxa), Fabaceae (9%; 10 taxa) and Lamiaceae (7%; eight taxa). Asteraceae, Brassicaceae and Poaceae were represented by five taxa each; Myrtaceae, Rosaceae and Zingiberaceae by four taxa each; and Amaranthaceae, Apocynaceae, Burseraceae and Rutaceae by three taxa each. Seven families were represented by two taxa and 24 families were represented only by one taxon. The most cited salient medicinal plants during the interviews are helba (Trigonella foenum-graecum), kamun (Cuminum cyminum), yansun (Pimpinella anisum), qurfa (Cinnamomum verum) and zanajabil (Zingiber officinale) (Table 2). Interestingly, we observed that one third (32%) of the plants mentioned in the interviews are common vegetable and fruit crops, and almost one fifth (17%) are spices. More than half of the taxa were not native to Saudi Arabia (54%; Table 2).
Table 2

Comprehensive inventory of the plants listed by women in Mecca including the scientific name and family, whether the plant is found in the Flora of Saudi Arabia and whether it is used as a food or spice, vernacular name(s), part(s) used, therapeutic use categories, preparation, administration, toxicity and side effects, frequency of citation and Smith’s S. For presence or absence in the Flora of Saudi Arabia, Y = yes, N = no, and for food and/or spice use, F = food and S = spice. Plants not documented in the selected literature are marked with ‘*’

Scientific name (family, voucher)

Flora of Saudi Arabia

Food (F) or spice (S)

Vernacular name(s) (Arabic)

Part(s) used

Therapeutic use categories

Preparation

Administration

Toxicological remarks and reported side effects

Frequency of citation

Smith’s S

Acacia nilotica (L.) Delile. (Fabaceae, EWM_62)

N

Qard (ضرق)

Fruit, root

Neurological, digestive

Infusion, decoction

Wash, bath

N

2

0.041

Acacia senegal (L.) Willd.

(Fabaceae, EWM_77)

N

Samg arabi (يبرع غمص)

Resin

Urological, endocrine and nutritional

Infusion

Oral ingestion (drink)

N

2

0.042

Aerva javanica (Burm.f.) Juss. ex Schult. (Amaranthaceae, EWM_90)

Y

Tarf (فرط)

All plant

Neurological, digestive

Infusion, ground

Oral ingestion (drink), put directly on the teeth

N

1

0.009

* Alchemilla sp. (Rosaceae, EWM_68)

Y

Rajel alasad (دسلآا لجر)

Root

Digestive

Infusion

Oral ingestion (drink)

Not to be used by pregnant women

1

0.01

*Alchemilla xanthochlora Rothm. (Rosaceae, EWM_01)

N

Abat alseda (ةأبع ةديسلا)

Leaf

Gynaecological

Infusion

Oral ingestion (drink)

N

1

0.021

Allium cepa L. (Amaryllidaceae, EWM_14)

N

F

Bsal (لصب)

Bulb, tunic

General and unspecified, gynaecological

Juice with lemon, added to food

Oral ingestion (drink or eat), fumigation, placing onions on the bottom of the feet and wear socks

N

4

0.034

Allium sativum L. (Amaryllidaceae, NA)

N

F

Thoom (موث)

Bulb

General and unspecified, cardiovascular, digestive, ear

Put with food, in water, mash, no preparation

Oral ingestion (eat or drink), put directly on the teeth

N

7

0.069

Aloe sp. (Xanthorrhoeaceae, EWM_74)

Y

Sabr (ربص)

Leaf flesh

Digestive, gynaecological, skin

Put in water

Oral ingestion (drink), topic on wounds

Causes diarrhoea

1

0.007

Aloe vera (L.) Burm.f. (Xanthorrhoeaceae, EWM_73)

N

Sabbar (رابص)

Leaf flesh

Skin

No preparation

Topic on wounds or hair

Overdose may cause colon cancer

2

0.041

*Alpinia officinarum Hance (Zingiberaceae, EWM_43)

N

S

Kholanjan (ناجنلوخ)

Rhizome

Digestive, cardiovascular, skin

Infusion

Oral ingestion (drink)

N

1

0.013

*Ammi visnaga (L.) Lam. (Apiaceae, EWM_44)

Y

S

Khull (ةلخ)

Seed, leaf, fruit

Cardiovascular, urological

Infusion

Oral ingestion (drink)

Overdose may cause dryness and hypotension, not to be used by pregnant women

4

0.053

Anastatica hierochuntica L. (Brassicaceae, EWM_34)

Y

Kaff maryam (فك ميرم)

Fruit

Family planning, gynaecological

Infusion

Oral ingestion (drink), topic

Can cause stomach disorders and nausea

4

0.04

Anethum graveolens L. (Apiaceae, EWM_81)

Y

S

Shabath (ثبش)

Leaf

Digestive

Infusion

Oral ingestion (drink)

Not to be used by those who suffer from kidney disease

1

0.004

*Apium graveolens L. (Apiaceae, EWM_46)

Y

F

Korfos (سفرك)

Leaf

Gynaecological, digestive, neurological

Infusion, juice, no preparation

Oral ingestion (eat or drink)

Not to be used by pregnant women

2

0.02

*Artemisia judaica L. (Asteraceae, EWM_87)

Y

Shayh (حيش)

All plant

Digestive

Infusion

Oral ingestion (drink)

Not to be used by pregnant women

1

0.007

*Avena sativa L. (Poaceae, EWM_88)

Y

F

Shuran (نافوش)

Seed

Endocrine and nutritional

Ground

Oral ingestion (eat)

N

1

0.002

Azadirachta indica A. Juss. (Meliaceae, EWM_60)

N

Nim (مين)

Leaf

Digestive, general and unspecified

Decoction

Oral ingestion (drink), bath

N

2

0.035

*Beta vulgaris L. (Amaranthaceae, EWM_09)

Y

F

Banjr (رجنب)

Fruit

Blood and immune mechanisms

Decoction, juice, no preparation

Oral ingestion (drink ore at)

N

7

0.054

Boswellia sacra Flueck. (Burseraceae, EWM_50)

N

Laban aldakar, laban shahari (نابل ،ركذلا يرحش نابل)

Resin

General and unspecified, respiratory, neurological

Infusion, chewing, fumigation

Oral ingestion (drink)

N

8

0.113

*Brassica oleracea L. (Brassicaceae, NA)

N

F

Kronb (بنرك)

Leaf

Digestive

Juice (with apples and milk), in food, decoction

Oral ingestion (drink or eat)

N

7

0.018

Brassica rapa L. (Brassicaceae, EWM_40)

N

F

Khardal (لدرخ)

Seed

Musculoskeletal, cardiovascular

Ground, infusion

In hot water (to put feet in)

N

2

0.028

Calotropis procera (Ait.) Ait. fil., (Apocynaceae, NA)

Y

Eshr (راشع)

Flower

Respiratory

In water, ground

Oral ingestion (drink or eat)

Can cause diarrhoea

1

0.005

*Camellia sinensis (L.) Kuntze (Theaceae, EWM_85)

N

F

Shay, shay akhdar (ياش, رضخأ ياش)

Leaf

Digestive, metabolic and nutritional, gynaecological, general and unspecified, family planning

Decoction, infusion

Topic, oral ingestion (drink), fumigation

When ingested, overdose may cause diarrhoea

7

0.09

Carthamus tinctorius L. (Asteraceae, EWM_61)

Y

Osforr (رفصع)

Flower

Endocrine and nutritional, cardiovascular

Infusion

Oral ingestion (drink)

Overdose may cause diarrhoea

1

0.03

*Carum carvi L. (Apiaceae, EWM_37)

N

S

Karawia (ةيوارك)

Seed

Digestive, gynaecological, general and unspecified, respiratory, family planning

Decoction

Oral ingestion (drink)

Overdose may affect the kidneys

6

0.111

Ceratonia siliqua L. (Fabaceae, EWM_41)

N

F

Kharnub (بونرخ)

Fruit

Digestive

Infusion

Oral ingestion (drink)

N

1

0.025

*Cinnamomum verum J. S. Presl (Lauraceae, EWM_67)

N

S

Qurfa (هفرق)

Bark

Gynaecological, digestive, blood and immune system, endocrine and nutritional, respiratory, family planning

Decoction, ground

Oral ingestion (eat or drink)

Overdose may cause fainting, hypotension, dizziness and sweating, bleeding if used for more than 3 days, not to be used with ginger, not to be used by pregnant women (may cause abortion)

20

0.349

Citrullus colocynthis (L.) Schrad. (Cucurbitaceae, EWM_28)

Y

Hanzal (لظنح)

Leaf, fruit

Digestive, skin

Infusion, no preparation

Oral ingestion (drink), topic

N

2

0.041

*Citrus sinensis (L.) Osbeck (Rutaceae, EWM_51)

N

F

Portokal (لاقترب)

Fruit

Digestive, general and unspecified

Juice, no preparation

Oral ingestion (eat or drink)

N

2

0.04

Citrus sp. (Rutaceae, EWM_51)

N

F

Limon (نوميل)

Fruit

General and unspecified, digestive, endocrine and nutritional, respiratory

Juice, dry until black and ground in water, decoction

Oral ingestion (drink), topic

N

10

0.201

Coffea arabica L. (Rubiaceae, EWM_64)

N

F

Qashr album (رشق نبللا)

Pericarp

Blood and immune system, gynaecological, endocrine and nutritional

Decoction, infusion

Oral ingestion (drink)

Not to be used by pregnant women

6

0.117

Commiphora gileadensis (L.) C. Christ. (Burseraceae, EWM_12

Y

Basham (ماشب)

Root

Gynaecological, general and unspecified, respiratory, neurological

Decoction, infusion

Oral ingestion (drink), topic

N

3

0.051

Commiphora myrrha (Nees) Engl. (Burseraceae, EWM_53)

Y

Marr (رم)

Resin

Skin, digestive, respiratory, gynaecological, general and unspecified

In water, infusion

Poultice, mouthwash, oral ingestion (drink)

Overdose may upset the stomach and cause general discomfort

17

0.323

Coriandrum sativum L. (Apiaceae, EWM_47)

Y

F

Kozbra (ةربزك)

Leaf

Digestive, cardiovascular, neurological

Ground, infusion, with food

Oral ingestion (eat or drink)

Overdose may cause infertility

5

0.079

*Costus sp. (Costaceae, EWM_63)

N

Qasd hindi (يدنه دصق)

Root

Endocrine and nutritional, general and unspecified, gynaecological, blood and immune system, urological, family planning

Ground, decoction

Oral ingestion (eat or drink)

N

4

0.05

*Crocus sativus L. (Iridaceae, EWM_99)

N

S

Zafran (نارفعز)

Stigma

General and unspecified, digestive, respiratory

With food, in water

Oral ingestion (eat or drink)

Not to be used by pregnant women

3

0.025

Cucumis sativus L. (Cucurbitaceae, NA)

N

F

Khiar (رايخ)

Fruit

Urological, digestive, neurological

No preparation

Oral ingestion (eat)

N

2

0.033

Cuminum cyminum L. (Apiaceae, EWM_36)

Y

S

Kamun (نومك)

Seed

Digestive, gynaecological, endocrine and nutritional, general and unspecified, respiratory

Infusion, decoction, ground

Oral ingestion (eat or drink)

Overdose may upset the stomach and produce constipation)

22

0.486

Curcuma longa L. (Zingiberaceae, EWM_38)

N

S

Karrakum (مكرك)

Rhizome

Musculoskeletal, skin, blood and immune system, general and unspecified, digestive, respiratory, endocrine and nutritional

Ground, infusion, with honey

Oral ingestion (eat or drink), poultice

Overdose may upset the stomach

8

0.09

*Cydonia oblonga Mill. (Rosaceae, NA)

N

F

Safarjil (لجرفس)

Fruit

Digestive

No preparation

Oral ingestion (eat)

N

1

0.02

*Cymbopogon schoenanthus (L.) Spreng. (Poaceae, EWM_02)

Y

Adhkhur (رخذا)

Leaf

Neurological, digestive, urological, general and unspecified

Decoction

Oral ingestion (drink), decoction (steam inhalation)

N

3

0.069

*Dialium sp. (Fabaceae, EWM_26)

N

Hamayd (ضيمح)

Fruit

Digestive, urological

Infusion

Oral ingestion (drink)

N

1

0.008

*Dipterygium glaucum Decne. (Cleomaceae, EWM_06)

Y

Arfaj (جفرع)

Leaf

Digestive, respiratory

Infusion

Oral ingestion (drink), decoction (steam inhalation)

N

1

0.003

*Dracaena cinnabari Balf.f. (Asparagaceae, EWM_16)

N

Dam alakhwan (مد نيوخلأا)

Resin

General and unspecified, digestive

Ground

Poultice

N

1

0.006

*Elettaria cardamomum (L.) Maton (Zingiberaceae, EWM_24)

N

S

Hal (لاه)

Fruit, seed

Respiratory

Infusion

Oral ingestion (drink)

N

1

0.004

Eruca sp. (Brassicaceae, EWM_33)

Y

Jarjir (ريجرج)

Leaf

Blood and immune system, respiratory

With food, no preparation

Oral ingestion (eat or drink)

N

9

0.133

Eucalyptus camaldulensis Dehnh. (Myrtaceae, EWM_35)

N

Kafor (روفاك)

Leaf

Neurological, digestive, general and unspecified

Infusion, decoction

Oral ingestion (drink)

N

3

0.035

Ferula assa-foetida L. (Apiaceae, EWM_25)

N

Halatayta (ةتيتلح)

Resin

Digestive, respiratory

Maceration

Oral ingestion (drink)

Not to be used by breastfeeding women, children should not take more than 5 ml

4

0.068

Ficus palmata Forssk. (Moraceae, NA)

Y

F

Hamat (طامح)

Fruit

Digestive

No preparation

Oral ingestion (eat)

N

1

0.007

Foeniculum vulgare Mill. (Apiaceae, EWM_83)

Y

S

Shamr (رمش)

Seed

Digestive, urological, gynaecological, general and unspecified, neurological, blood and immune system

Infusion, decoction, ground

Oral ingestion (drink or eat)

Overdose may cause inflammation of the intestines

14

0.248

*Fucus vesiculosus L. (Fucaceae, EWM_21)

N

Foqus (سقوف)

Leaf

Endocrine and nutritional, cardiovascular

Infusion

Oral ingestion (drink)

N

1

0.004

*Glebionis coronaria (L.) N.N. Tzvel. (Asteraceae, EWM_04)

N

Aqhwan (ناوحقا)

Leaf, flower

Digestive

Infusion

Oral ingestion (drink)

Not recommended for babies

1

0.004

Glycyrrhiza glabra L. (Fabaceae, EWM_18)

Y

Eirqsos (سوسقرع)

Root

Digestive, musculoskeletal

Infusion

Oral ingestion (drink)

N

1

0.023

*Hibiscus sabdariffa L. (Malvaceae, EWM_49)

N

Kwajara karakadi (،يتارجوك ةيدكرك)

Calyx, sepal

Cardiovascular, blood and immune system, digestive, urological, neurological

Infusion, decoction

Oral ingestion (drink)

N

15

0.209

*Hordeum vulgare L. (Poaceae, EWM_82)

Y

F

Shaeir (ريعش)

Seeds

Urological, digestive

Decoction

Oral ingestion (drink)

Not to be used by pregnant women

5

0.041

*Hyphaene sp. (Arecaceae, EWM_17)

Y

Dom (مود)

Fruit

Cardiovascular

Ground, infusion with honey

Oral ingestion (drink)

N

1

0.026

Juniperus procera Hochst. ex Endl. (Cupressaceae, EWM_05)

Y

Arar (رعرع)

Fruit

Urological

Infusion, decoction

Oral ingestion (drink)

Not to be used by pregnant women

1

0.006

*Lactuca sativa L. (Asteraceae, NA)

N

F

Khas (سخ)

Leaf

Blood and immune system, urological, digestive

With food

Oral ingestion (eat)

N

2

0.02

*Laurus nobilis L. (Lauraceae, EWM_93)

N

S

Waraq alghar (قرو راغلا)

Leaf

Urological, general and unspecified

Infusion

Oral ingestion (drink)

N

1

0.007

Lawsonia inermis L. (Lythraceae, EWM_27)

Y

Hana (انح)

Leaf

Neurological, musculoskeletal, skin

Ground, with honey in water

Topic, poultice

N

3

0.03

Lepidium sativum L. (Brassicacea, EWM_70)

Y

S

Rashad, thafa (،داشر ءافث)

Seed

Gynaecological, musculoskeletal, skin, digestive, endocrine and nutritional, neurological, general and unspecified, cardiovascular

Ground, infusion, no preparation

Oral ingestion (eat or drink), poultice

Not to be used for over a month, nor by pregnant women, overdose may cause diarrhoea and upset stomach

13

0.228

Linum usitatissimum L. (Linaceae, EWM_13)

Y

Bidharrat alkitan (ةرذب ناتكلا)

Seed

Digestive, endocrine and nutritional, general and unspecified, gynaecological

Ground, infusion

Oral ingestion (eat or drink)

Can cause stomach and abdominal pain, and gases

4

0.079

*Lupinus albus L. (Fabaceae, EWM_91)

N

F

Tarmas (سمرت)

Seed

Neurological, endocrine and nutritional, blood and immune system

With food, infusion, decoction

Oral ingestion (eat or drink)

Overdose may cause phlegm and skin yellowing

4

0.035

Lycopersicon esculentum Mill. (Solanaceae, NA)

N

F

Tamatum (مطامط)

Fruit

Blood and immune system

No preparation

Oral ingestion (eat)

Overdose may cause diarrhoea

1

0.023

Malva parviflora L. (Malvaceae, EWM_39)

Y

Khabiza (ةزيبخ)

Leaf, flower

Family planning, general and unspecified, respiratory

Infusion, no preparation

Chewing, oral ingestion (drink)

N

1

0.002

Matricaria aurea (L.) Sch. Bip. (Asteraceae, EWM_07)

Y

Babunj (جنوباب)

Flower

General and unspecified, neurological, cardiovascular, digestive, respiratory

Infusion

Inhale, oral ingestion (drink)

Overdose may cause dizziness or headache

9

0.134

*Melissa officinalis L. (Lamiaceae, EWM_52)

N

Malisaa (اسيلم)

Leaf

Digestive

Infusion

Oral ingestion (drink)

Not to be used by pregnant women or children

1

0.019

Mentha sp. (Lamiaceae, EWM_59)

Y

Nena (عانعن)

Leaf

Digestive, cardiovascular, general and unspecified, neurological, respiratory, gynaecological

Decoction, infusion

Oral ingestion (drink)

N

16

0.289

Morus nigra L. (Moraceae, EWM_95)

N

F

Waraq tawt (توت قرو)

Leaf

Family planning

Decoction

Oral ingestion (drink)

N

1

0.013

*Musa acuminata Colla (Musaceae, NA)

N

F

Moz (زوم)

Fruit

Digestive

No preparation

Oral ingestion (eat)

N

1

0.029

Myrtus communis L. (Myrtaceae, EWM_92)

Y

Waraq alas (سلاا قرو)

Leaf

General and unspecified, respiratory, blood and immune system, cardiovascular

Decoction, infusion

Oral ingestion (drink)

N

2

0.022

Nigella sativa L. (Ranunculaceae, EWM_22)

N

S

Haba sawda (ةبح ءادوس)

Seed

Blood and immune system, general and unspecified, respiratory, gynaecological, musculoskeletal, neurological

Ground, 7 seeds with honey or dates, no preparation

Oral ingestion (eat or drink)

Not to be used by pregnant women, children, or babies, if more than 7 seeds are taken in a day, it can cause abortion, overdose may affect the kidneys

13

0.201

Ocimum basilicum L. (Lamiaceae, EWM_71)

N

Rihan (ناحير)

Leaf, flower

General and unspecified, respiratory

Infusion

Oral ingestion (drink)

N

1

0.006

Ocimum sp. (Lamiaceae, EWM_23)

Y

Habaq (قبح)

Leaf

General and unspecified, digestive

Decoction, infusion

Oral ingestion (drink)

Not to be used by pregnant women or children

3

0.04

Olea europaea L. (Oleaceae, EWM_101)

Y

F

Zeetoun (نوتيز)

Oil, leaf

General and unspecified, endocrine and nutritional, respiratory

Syrup, liniment, infusion, decoction

Oral ingestion (eat or drink), liniment

If boiled (leaves) may become toxic, overdose may cause diarrhoea

5

0.086

*Origanum majorana L. (Lamiaceae, EWM_11)

N

Bardaqush (شوقدرب)

Leaf

Endocrine and nutritional, urological, digestive, musculoskeletal, cardiovascular

Infusion, decoction

Oral ingestion (drink)

N

5

0.078

*Pennisetum glaucum (L.) R.Br. (Poaceae, EWM_15)

Y

F

Dakhun (نخد)

Seed

Digestive

Ground

Oral ingestion (eat)

N

1

0.015

Petroselinum crispum (Mill.) Fuss (Apiaceae, EWM_10)

N

F

Baqdunas (سنودقب)

Leaf

Cardiovascular, urological, female, gynaecological, blood and immune system, musculoskeletal, skin

Infusion, ground, decoction, juice, no preparation

Oral ingestion (eat or drink), wash

Overuse may cause skin irritation

10

0.163

Phoenix dactylifera L. (Arecaceae, NA)

Y

F

Nakhel, tamr (،ليخن رمت)

Fruit, seed

Family planning, digestive

Ground, in hot milk or honey

Oral ingestion (drink)

N

1

0.012

Pimpinella anisum L. (Apiaceae, EWM_96)

N

S

Yansun (نوسناي)

Seed

Digestive, gynaecological, respiratory, general and unspecified, urological, neurological

Decoction, infusion

Oral ingestion (drink)

Overdose may cause abdominal distension

21

0.559

Piper nigrum L. (Piperaceae, EWM_20)

N

S

Flfl aswad, flfl abyad (،دوسا لفلف, ضيبا لفلف)

Fruit

Respiratory, gynaecological, digestive, urological

Ground

Oral ingestion (eat or drink)

Overdose may cause heartburn

6

0.084

Pistacia lentiscus L. (Anacardiaceae, EWM_57)

N

Mustaka (اكتسم)

Resin

General and unspecified, musculoskeletal

In small pieces on a gauze with lemon

Poultice

N

1

0.008

*Prunus mahaleb L. (Rosaceae, EWM_55)

N

F

Mhallab (بلحم)

Seed

Digestive, general and unspecified

Ground, infusion

Rubbed on gums, topic, oral ingestion (drink), poultice

N

4

0.069

*Psidium guajava L. (Myrtaceae, EWM_94)

N

F

Waraq jawwafa (قرو ةفاوج)

Leaf

General and unspecified, respiratory, neurological

Decoction, infusion

Oral ingestion (drink)

N

7

0.106

Punica granatum L. (Lythraceae, EWM_72)

N

F

Roman (نامر)

Peel

Digestive, skin, gynaecological

Ground, decoction

Oral ingestion (eat), poultice, topic

N

7

0.103

Rhazya stricta Decne. (Apocynaceae, EWM_30)

Y

Harmal (لمرح)

Leaf, root

General and unspecified, digestive

Decoction, ground, infusion

Oral ingestion (drink)

Can cause dizziness and sleeping problems, overdose can be toxic

4

0.08

*Rheum sp. (Polygonaceae, EWM_69)

Y

Raoud (دنوار)

Leaf, root

Digestive

Infusion

Oral ingestion (drink)

Not to be used by pregnant or breastfeeding women, or people with kidney problems

1

0.017

Ricinus communis L. (Euphorbiaceae, EWM_45)

Y

Khurue (عورخ)

Seeds, oil

Digestive, musculoskeletal, skin

Liniment, in juice

Oral ingestion (drink)

Not to be used by pregnant women

2

0.033

*Rosmarinus officinalis L. (Lamiaceae, EWM_03)

N

Aklel aljabal (ليلكا لبجلا)

Leaf

Respiratory, general and unspecified, digestive, neurological, cardiovascular

Ground, infusion

Oral ingestion (eat or drink), decoction (steam inhalation)

Not to be used by pregnant women or patients with blood pressure problems

6

0.1

Ruta chalepensis L. (Rutaceae, EWM_84)

Y

Shathab (باذش)

Leaf

Neurological, ear, respiratory

Decoction

Oral ingestion (drink)

Overdose may cause sleepiness, cirrhosis, abortion

1

0.024

*Salix mucronata Thunb. (Salicaceae, EWM_76)

Y

Safsaf (فاصفص)

Leaf

Musculoskeletal

Infusion

Oral ingestion (drink)

N

1

0.003

*Salvia officinalis L. (lamiaceae, EWM_56)

N

Miramia (ةيماريم)

Leaf

General and unspecified, digestive, gynaecological, neurological

Decoction, infusion

Oral ingestion (drink), mouthwash

Not to be used during menstruation, increases production of milk

5

0.106

Senna alexandrina Mill. (Fabaceae, EWM_78)

Y

Sana maki (يكم انس)

Leaf

Digestive, gynaecological

Decoction

Oral ingestion (drink)

Dry, not to be used by pregnant and breastfeeding women

8

0.195

Sesamum indicum L. (Pedaliaceae, EWM_89)

Y

F

Smsm (مسمس)

Seed

Neurological, endocrine and nutritional

In food, ground, no preparation

Oral ingestion (eat)

N

2

0.039

*Solenostemma argel (Delile) Hayne (Apocynaceae, EWM_29)

N

Hargal (لجرح)

Leaf

Musculoskeletal, digestive, blood and immune system, endocrine and nutritional

Ground, in water

Topic, oral ingestion (drink)

Not to be used by pregnant or breastfeeding women

2

0.042

*Spinacia oleracea L. (Amaranthaceae, EWM_80)

N

F

Sbanekh (خنابس)

Leaf

Blood and immune system, digestive, general and unspecified

With food

Oral ingestion (eat)

N

4

0.052

Syzygium aromaticum (L.) Merr. & Perry (Myrtaceae, EWM_66)

N

S

Qrnfol (لفنورق)

Flower bud

Digestive, general and unspecified, endocrine and nutritional, neurological, blood and immune system

Ground, infusion

Oral ingestion (drink), put directly on teeth

Overdose may upset the stomach, not to be used by people with liver problems

14

0.22

Tamarindus indica L. (Fabaceae, NA)

Y

F

Tamrr hindi, homar (رمت رمح ،يدنه)

Fruit

General and unspecified, digestive, skin

In water, decoction

Oral ingestion (drink), poultice

N

2

0.034

Thymus vulgaris L. (Lamiaceae, EWM_98)

N

Zaetir (رتعز)

Leaf

General and unspecified, respiratory, digestive, gynaecological, cardiovascular, neurological

In water or tea, decoction, infusion, in food

Oral ingestion (eat or drink)

Overdose may cause digestion

7

0.114

Trachyspermum ammi (L.) Sprague (Apiaceae, EWM_58)

Y

S

Nankha (ةخنان)

Seed

Digestive, musculoskeletal, gynaecological

Ground

Oral ingestion (eat or drink)

Overdose may cause constipation

7

0.062

Trigonella foenum-graecum L. (Fabaceae, EWM_31)

Y

S

Helba (ةبلح)

Seed

Family planning, digestive, gynaecological, musculoskeletal, blood and immune system, endocrine and nutritional, urological, respiratory, general and unspecified

Ground in milk, decoction, infusion

Oral ingestion (drink)

Use is not recommended for children under 2, overdose may cause nausea or overweight

24

0.56

*Triticum aestivum L. (Poaceae, EWM_32)

N

F

Janen alqmah (نينج حمقلا)

Seed

Neurological, cardiovascular

Ground

Oral ingestion (eat)

Overdose may cause overweight

1

0.022

*Vigna radiata (L.) R. Wilczek (Fabaceae, EWM_54)

N

F

Mash (شام)

Seed

Neurological, general and unspecified, blood and immune system, musculoskeletal, endocrine and nutritional

With food, ground, decoction

Oral ingestion (eat or drink)

Can cause overweight

8

0.1

*Viola sp. (Violaceae, EWM_08)

Y

Banafsj (جسفنب)

Leaf, flower

Respiratory

No preparation

Sublingual, chewing

N

1

0.031

Vitis sp. (Vitaceae, EWM_97)

N

F

Zabib (بيبز)

Fruit

Blood and immune system, neurological, endocrine and nutritional

In food, with juice

Oral ingestion (eat or drink)

N

5

0.086

Zingiber officinale Roscoe (Zingiberaceae, EWM_100)

N

S

Zanajabil (ليبجنز)

Root

General and unspecified, musculoskeletal, digestive, endocrine and nutritional, cardiovascular, respiratory, neurological, blood and immune system

Decoction, infusion, ground

Oral ingestion (drink)

Overdose may cause heartburn or skin reactions

18

0.294

Ziziphus spina-christi (L.) Desf. (Rhamnaceae, EWM_75)

Y

Sader (ردس)

Leaf

Skin

Infusion, ground

Wash

N

2

0.015

Not identified (Cupressaceae, EWM_65)

Qatiran (نارطق)

Oil

Skin

Liniment

Topic

N

1

0.005

Not identified (EWM_79)

Saq alhamam, khawa jawa (قاس ،مامحلا اوجاوخ)

Root

Skin

Ground

Poultice

N

2

0.049

Not identified (EWM_48)

Krela (لايرك)

Fruit

Endocrine and nutritional

Ground

Oral ingestion (eat)

N

1

0.031

The modes of preparation and administration for each plant can be found in Table 2. The most used plant parts are leaves (35%), fruits (21%) and seeds (18%). Underground parts (9%), flowers (8%), resin (5%), oil (2%), the whole plant (2%) and bark (1%) are also used. Infusion is the most used mode of preparation (26%), followed by decoction (22%), grinding (22%), mixing with food (7%) and maceration (6%). Plants are sometimes used as they were sourced without any (further) preparation process (5%), juiced (4%) or mixed with dates (2%), milk (1%), honey (1%) or fruits (1%). The most popular modes of administration are oral ingestion as a drink (63%) and eaten (21%). Plants are also administered as poultices (7%) or applied directly on the teeth (2%). They are rarely (1%) used in mouthwash, fumigation and lotions, inhaled, chewed, rubbed or used as washes.

A total of 67 mixtures were documented including combinations of two to four plant ingredients (Table 3). Forty-four medicinal plants (40%) were sometimes used in the mixtures. The medicinal plants most commonly used in mixtures are Ziziphus spina-christi (zanajabil) cited in 17 mixtures and Pimpinella anisum (yansun), Mentha sp. (nena) and Citrus sp. (limon) each cited in 10 mixtures. The most common mixtures are the combination of Pimpinella anisum, Carum carvi and Foeniculum vulgare used as a digestive, for gynaecological and urological problems; Pimpinella anisum, Cuminum cyminum and Foeniculum vulgare for digestive problems; and Trigonella foenum-graecum, Foeniculum vulgare and Pimpinella anisum for digestive, respiratory and neurological problems. Modes of administration for mixtures are limited to decoctions and infusions and dried and ground plants added to food.
Table 3

Mixtures and combinations used by women in Mecca

Mixture

Medicinal plants included (vernacular and scientific names)

Mix1

Qashr albun (Coffea arabica), nakhel, tamr (Phoenix dactylifera), kamun (Cuminum cyminum)

Mix2

Zeetoun (Olea europaea), limon (Citrus sp.)

Mix3

Zeetoun (Olea europaea), dakhun (Pennisetum glaucum)

Mix4

Yansun (Pimpinella anisum), karawia (Carum carvi), shamr (Foeniculum vulgare)

Mix5

Marr (Commiphora myrrha), rashad, thafa (Lepidium sativum), haba sawda (Nigella sativa)

Mix6

Shay, shay akhdar (Camellia sinensis), kamun (Cuminum cyminum)

Mix7

Yansun (Pimpinella anisum), kamun (Cuminum cyminum), shamr (Foeniculum vulgare)

Mix8

Nena (Mentha sp.), shay, shay akhdar (Camellia sinensis), zanajabil (Zingiber officinale)

Mix9

Karawia (Carum carvi), helba (Trigonella foenum-graecum), kamun (Cuminum cyminum)

Mix10

Nena (Mentha sp.), shay, shay akhdar (Camellia sinensis)

Mix11

Qrnfol (Syzygium aromaticum), hal (Elettaria cardamomum), qashr albun (Coffea arabica)

Mix12

Yansun (Pimpinella anisum), shamr (Foeniculum vulgare)

Mix13

Helba (Trigonella foenum-graecum), shamr (Foeniculum vulgare), yansun (Pimpinella anisum)

Mix14

Qashr albun (Coffea arabica), shamr (Foeniculum vulgare), yansun (Pimpinella anisum), haba sawda (Nigella sativa)

Mix15

Nena (Mentha sp.), limon (Citrus sp.), zanajabil (Zingiber officinale)

Mix16

Limon (Citrus sp.), kamun (Cuminum cyminum)

Mix17

Yansun (Pimpinella anisum), bardaqush (Origanum majorana)

Mix18

Marr (Commiphora myrrha), karrakum (Curcuma longa)

Mix19

Marr (Commiphora myrrha), haba sawda (Nigella sativa), shamr (Foeniculum vulgare), nankha (Trachyspermum ammi)

Mix20

Zanajabil (Zingiber officinale), shay, shay akhdar (Camellia sinensis)

Mix21

Zanajabil (Zingiber officinale), qashr albun (Coffea arabica)

Mix22

Nankha (Trachyspermum ammi), kozbra (Coriandrum sativum)

Mix23

Nena (Mentha sp.), bardaqush (Origanum majorana), habaq (Ocimum sp.)

Mix24

Marr (Commiphora myrrha), shay, shay akhdar (Camellia sinensis)

Mix25

Zanajabil (Zingiber officinale), karrakum (Curcuma longa)

Mix26

Kaff maryam (Anastatica hierochuntica), halatayta (Ferula assa-foetida), marr (Commiphora myrrha)

Mix27

Basham (Commiphora gileadensis), roman (Punica grantum), qrnfol (Syzygium aromaticum)

Mix28

Nena (Mentha sp.), zanajabil (Zingiber officinale)

Mix29

Aklel aljabal (Rosmarinus officinalis), zanajabil (Zingiber officinale)

Mix30

Limon (Citrus sp.), zanajabil (Zingiber officinale)

Mix31

Limon (Citrus sp.), nena (Mentha sp.)

Mix32

Qrnfol (Syzygium aromaticum), haba sawda (Nigella sativa), zanajabil (Zingiber officinale)

Mix33

Haba sawda (Nigella sativa), qurfa (Cinnamomum verum)

Mix34

Qrnfol (Syzygium aromaticum), hal (Elettaria cardamomum)

Mix35

Qrnfol (Syzygium aromaticum), hana (Lawsonia inermis)

Mix36

Basham (Commiphora gileadensis), adhkhur (Cymbopogon schoenanthus)

Mix37

Zanajabil (Zingiber officinale), qurfa (Cinnamomum verum)

Mix38

Nena (Mentha sp.), limon (Citrus sp.), zanajabil (Zingiber officinale)

Mix39

Yansun (Pimpinella anisum), shay, shay akhdar (Camellia sinensis), nena (Mentha sp.)

Mix40

Zanajabil (Zingiber officinale), flfl abyad, flfl aswad (Piper nigrum)

Mix41

Zanajabil (Zingiber officinale), limon (Citrus sp.), qashr albun (Coffea arabica)

Mix42

Sana maki (Cassia senna), tamrr hindi, homar (Tamarindus indica)

Mix43

Nankha (Trachyspermum ammi), kamun (Cuminum cyminum), shamr (Foeniculum vulgare)

Mix44

Kamun (Cuminum cyminum), karrakum (Curcuma longa)

Mix45

Nankha (Trachyspermum ammi), kamun (Cuminum cyminum), shamr (Foeniculum vulgare), haba sawda (Nigella sativa)

Mix46

Bsal (Allium cepa), limon (Citrus sp.)

Mix47

Helba (Trigonella foenum-graecum), yansun (Pimpinella anisum), shamr (Foeniculum vulgare)

Mix48

Haba sawda (Nigella sativa), yansun (Pimpinella anisum), qrnfol (Syzygium aromaticum)

Mix49

Qashr albun (Coffea arabica), zanajabil (Zingiber officinale)

Mix50

Hargal (Solenostemma argel), raond (Rheum sp.)

Mix51

Zanajabil (Zingiber officinale), qurfa (Cinnamomum verum)

Mix52

Zanajabil (Zingiber officinale), nena (Mentha sp.), kamun (Cuminum cyminum)

Mix53

Nena (Mentha sp.), helba (Trigonella foenum-graecum)

Mix54

Qrnfol (Syzygium aromaticum), qurfa (Cinnamomum verum), zanajabil (Zingiber officinale), hal (Elettaria cardamomum)

Mix55

Helba (Trigonella foenum-graecum), mash (Vigna radiata)

Mix56

Yansun (Pimpinella anisum), habaq (Ocimum sp.)

Mix57

Qashr albun (Coffea arabica), qurfa (Cinnamomum verum)

Mix58

Portokal (Citrus sinensis), limon (Citrus sp.)

Mix59

Mhallab (Prunus mahaleb), hana (Lawsonia inermis), qrnfol (Syzygium aromaticum)

Mix60

Qashr albun (Coffea arabica), qurfa (Cinnamomum verum), qrnfol (Syzygium aromaticum)

Mix61

Nim (Azadirachta indica), harmal (Rhazya stricta), sader (Ziziphus spina-christi)

Mix62

Nankha (Trachyspermum ammi), limon (Citrus sp.)

Mix63

Nankha (Trachyspermum ammi), qashr albun (Coffea arabica)

Mix64

Nankha (Trachyspermum ammi), haba sawda (Nigella sativa), rashad, thafa (Lepidium sativum)

Mix65

Rashad, Thafa (Lepidium sativum), nakhel, tamr (Phoenix dactylifera)

Mix66

Haba sawda (Nigella sativa), nakhel, tamr (Phoenix dactylifera)

Mix67

Hargal (Solenostemma argel), raond (Rheum sp.), hndba (chicory), aomloj (Phyllanthus cf.)

Ailments treated with medicinal plants by women in Mecca and remarks on side effects

Medicinal plant uses were documented for 13 etic therapeutic use categories (Table 4). Almost half of the use reports referred to digestive, general and unspecified and respiratory issues, which are common children’s, as well as adult’s, complaints, but do not reflect the most important diseases afflicting the Saudi Arabian population (cardiovascular diseases, diabetes, neuro-psychiatric conditions and injuries [57]). Gynaecological problems, which encompass menstrual cramps and other menstrual disorders, polycystic ovaries, pregnancy and postpartum issues, are fourth in importance both in number of use reports and number of plant taxa used.
Table 4

Use reports and number of taxa used for each therapeutic use category

Emic therapeutic use category

Number of use reports

Number of plant taxa

Digestive

215

67

General and unspecified

96

43

Respiratory

70

32

Gynaecological

60

29

Endocrine and nutritional

53

24

Blood and immune system

50

21

Neurological

48

29

Musculoskeletal

38

16

Cardiovascular

36

19

Urological

36

17

Skin

34

16

Family planning

15

9

Ear

2

2

Informants indicated potentially toxic or side effects for almost half of the medicinal plants (n = 52, 47%), often associated with inappropriate use (especially overdosing; Table 2). Many observations on plants’ side effects or toxicology made by informants referred to the negative effects of plants on pregnant or breastfeeding women (53% of the plants with noted side effects), or children (11%), and as causing digestive issues (37%) amongst other problems (30%).

Acquiring medicinal plant knowledge and choosing health care

Social and family networks, as well as mass media, were the two sources of medicinal plant knowledge mentioned by the Meccan women interviewed, who were all responsible for the household health. The same sources have been documented for herbal knowledge among the population of Riyadh [33]. Most elderly women interviewed mentioned that they had learned about medicinal plants from their mothers, grandmothers and neighbours (Table 1). Mecca’s everyday social interactions among women provide plenty of opportunities for the younger generation to learn from older women’s experience about medicinal plant use. Informant 18 (age 60, housewife) mentioned: ‘We always encourage our daughters to help us in the preparation of medicinal plants from early age’. Although some younger women interviewed acknowledged learning about medicinal plant knowledge from their elders, written sources, such as popular books on medicinal plants, were also mentioned as sources of medicinal plant knowledge (Table 1). Women of all ages also mentioned television programs as a source of knowledge about medicinal plants; mass media is put forward by biomedical practitioners as a tool for educational programs to modernise health concepts and make aware of available treatments among the poorly educated [34].

Overall, most of the women interviewed (n = 21, 66%) preferred to use medicinal plants rather than biomedicine, but others (n = 11, 34%) preferred biomedicine. Medicinal plants were more often preferred by older than younger women (Table 1). However, preference for medicinal plants also varied depending on the ailment that needed treating. Plants were often preferred to treat general malaise, digestive, respiratory, nutritional, neurological, musculoskeletal, cardiovascular, urological, skin and pregnancy-related ailments, some gynaecological problems and anaemia. The women interviewed preferred to use biomedicine in cases of psychological illnesses, eye problems, cancer, unusual gynaecological bleeding, wounds and infectious diseases. Often, they would prefer biomedicine when they suffer an illness for the first time but use medicinal plants for minor, common or chronic ailments. Informant 22 (45 years old) explained: ‘I usually prefer to use medicinal plants to treat my family for diseases that happen continuously such as headache, abdominal pains and menstruation, as well as those that occur due to climate changes such as flu and cough. I use biomedical resources with infectious and psychological diseases, such as depression’. A similar observation was made by Ghazanfar [36] when describing medicinal plant use in the Arabian Peninsula as a whole.

Medicinal plants used among urban, Muslim women are vastly under-documented

Four books and seven scientific articles published between 1985 and 2014 were retrieved from the literature search (Table 5). Most literature sources on medicinal plants from Saudi Arabia did not provide information on the ethnobotanical methods used nor cite robust plant identification procedures (Table 5), including six studies that did not mention the geographical area in which they were conducted. Of the 11 studies reviewed, plants were identified by experts in nine of them and only four cited one or more botanical keys used to identify collected taxa; eight studies reported the collection of voucher specimens. However, only four of these eight studies reported the voucher numbers in the publications. Four of the studies were identified as rigorous, hence suitable to compare with medicinal plant uses with the list of medicinal plants collected during fieldwork: Ghazanfar [36], Al-Sodany et al. [41], El-Ghazali et al. [58] and Abdulafatih [59] (Table 5). Although studies were selected if there was evidence for accurate plant identification, several plant synonyms were found to be used in these publications (according to The Plant List [54]) and misspelled plant names were not infrequent. Three plant names (8%) used in these literature sources could not be found when cross-checking with The Plant List [54], and six plants cited were identified only at the genus level.
Table 5

Reviewed Saudi Arabian medicinal plant literature

Reference

Study area

N plant species identified

Ethnobotanical data collection

Botanical keys used

Botanical identification by experts

Herbaria

Vouchers

Voucher numbers reported

Shalaby et al (1985)—book in English [68]

Not specified

160

Fieldwork to collect plant specimens and records local names

Yes

Yes

Umm Al-Qura University

No

No

Mossa et al (1987)—book in English [35]

Not specified

150

Not reported

No

No

King Saud University

No

No

Abdulafatih (1987)—journal article in English [59]

Asir region and surrounding areas (SW KSA)

61

Fieldwork documentation: local names, plant parts used and medicinal uses, reported

No

Yes

King Saud University (College of Education, Abha Branch)

Yes

Yes

Al-Yaha et al (1990)—book in English [63]

Not specified

150

Not reported

No

Yes

King Saud University

Yes

No

Ghazanfar (1994)—book in English [36]

Arabian peninsula

260

Fieldwork documentation and literature sources (1982–1993)

No

Yes

Sultan Qaboos University (Department of Biology; Sultanate of Oman)

Yes

No

Rahman et al (2004)—journal article in English [69]

Not specified

254

Literature and herbarium sources (College of Pharmacy, King Saud University, National Herbarium of Saudi Arabia)

No

No

King Saud University (College of Pharmacy, King Saud University, National Herbarium of Saudi Arabia)

Yes

No

El-Ghazali et al (2010)—journal article in English [58]

Al-Rass province, Qassim area

47

Fieldwork documentation: interviews with local healers and knowledgeable Bedouin; local names, plant parts used and medicinal uses, reported

No

Yes

Qassim University (Museum of Science, College of Science and Arts, Al-Rass)

Yes

Yes

Al-Sodany et al (2013)—journal article in English [41]

Taif

261 (165 medicinal)

Fieldwork documentation: interviews with local environments. Literature review

Yes

Yes

Kafr El-Sheikh University (Herbarium of Biology Department, Faculty of Science, Taif)

Yes

No

Youssef (2013)—journal article in English [70]

Qassim and central Saudi Arabia

83

Fieldwork documentation: open-ended interviews. Literature review

Yes

Yes

Qassim University

No

No

Shahat et al (2015)—journal article in English [71]

Tanhat protected area, Riyadh

7

Not reported

No

Yes

King Sud University (Medicinal and Aromatic Plants Research Department, National Research Centre; Herbarium of the Faculty of Pharmacy)

Yes

Yes

Yusuf et al (2014)—journal article in English [72]

Not specified

61

Literature review

Yes

Yes

King Saud University (Herbarium of the College of Pharmacy)

Yes

Yes

The four selected literature sources, all documenting medicinal plant knowledge in rural areas, cited 486 different medicinal plant species, compared to the 95 plants we identified at the species level cited by the 32 women interviewed (Table 2). Combining literature and fieldwork sources results in 525 different species used in Saudi Arabia in total. Five plants identified at the genus level were also new citations of these genera used medicinally in Saudi Arabia. Table 6 presents a comparison between Meccan women’s knowledge and each literature source (taking into account only the plants that could be identified at the species level). Medicinal plants known to the Meccan women interviewed contributed 7.4% of the total list: 39 species (41%) cited by women in Mecca were not reported in the selected Saudi Arabian medicinal plant literature (Table 6; indicated by ‘*’ in Table 5), whereas 56 species (59%) had been previously documented. Of the 56 species already cited in the literature, we documented new vernacular names for nine plants (10%). Forty plants were documented in the literature and were cited for different therapeutic applications by the Meccan women interviewed in this study.
Table 6

Comparison of medicinal plants used by Meccan women (MW) identified at the species level (n = 95) with the inventories from selected literature sources. NA indicates that a source did not provide vernacular names or therapeutic uses

Reference (rural/urban)

Total number of species listed

New citations by MW

Species with different vernacular names

Species with different therapeutic uses

Abdulafatih 1987 (rural) [59]

61

81 (85%)

84 (88%)

85 (89%)

Al-Sodany et al. 2013 (rural) [41]

165

82 (86%)

NA

NA

El-Ghazali et al. 2010 (rural) [58]

47

87 (92%)

88 (93%)

90 (95%)

Ghazanfar 1994 (not specified) [36]

260

43 (45%)

53 (56%)

55 (58%)

Total literature

486

39 (41%)

48 (51%)

79 (83%)

Discussion

Edible, traded and Muslim medicinal plants

Urbanisation is often considered an aspect of modernisation that leads to the erosion of medicinal plant knowledge [6], but urban contexts may have vibrant medicinal plant use traditions [37]. In the Middle East, urban male herbalists are acclaimed for their specialist medicinal plant knowledge [43]. In this study, we evidence a rich body of female, lay medicinal plant knowledge, supporting the observation by Elolemy and AlBedah [33] that women commonly use herbal therapies in Saudi Arabian cities. Although only 32 Meccan women participated in this study, more than 100 medicinal plants were documented to treat a wide range of health complaints. The knowledge held by women in cities is markedly different from knowledge previously documented, with 41% of the plants cited by Meccan women not in the literature we sourced. This points to the under-documentation of knowledge of medicinal plants in Saudi Arabia but cannot be attributed to male versus female knowledge or urban versus rural knowledge in the absence of further studies. Existing studies may also exclude foods, spices and culinary herbs from ethnobotanical listings of medicinal plants, making less visible knowledge held by women and contributing to the difference we find between published studies and our results.

A third (32%) of the medicinal plants used by the Meccan women interviewed are food plants. Salient food plants cited in this study include onion, celery, cabbage, coriander, lemon, olive oil and dates (Table 2). The use of food plants as medicines by urban populations is widespread [6] and may be due to the easy access to these plants. Medicinal foods are also an important feature of the Mediterranean medical tradition, observed specifically in the Greek Hippocratic texts that influenced Dioscorides’ Materia Medica [60], which in turn influenced Arabic medicinal texts [36]. Specific health beliefs associated with foods have also been observed in Arabia [36]. Along with food plants, many medicinal plants reported are spices (17%), which have played a double role as flavouring and medicinal products since the Middle Ages [61]. The most salient medicinal plants identified here are also all spices (Trigonella foenum-graecum, Cuminum cyminum, Pimpinella anisum, Cinnamomum verum and Zingiber officinale). Spices are both grown in the Middle East and imported from Africa and Southeast Asia (including plants from the Zingiberaceae, Piperaceae, Theaceae, Costaceae, Fucaceae and Musaceae families). This use of imported spices may be a legacy from trade Roman times, when black pepper, ginger, turmeric and cardamom were transported from Southeast Asia into the Mediterranean through Arabian incense trade routes [18, 20]. Moreover, medicinal plant use in urban environments biased towards exotic plants has been observed in Brazil [5] and could also be attributed to easier access to these plants in urban areas. The important use of foods and spices medicinally in cities may be a global characteristic of urban ethnobotanical knowledge, since these are often easily available in urban environments.

Plant availability is a key factor shaping traditional plant use. In urban areas, this does not necessarily reflect the region’s native plant diversity but the plant diversity traded and available in shops and markets. Differences in plant availability between rural and urban contexts may also account for the differences in plant lists reported in this study and published literature. El-Ghazali et al. [58] observed that native plants used by rural populations in Al-Rass province are not traded in domestic markets, and traded plants in shops and markets form the bulk of the medicinal plants available to Meccan women.

Food plants and spices represented half of the medicinal plants used by the Meccan women interviewed (49%), and many of these are plants cited in the Quran or the Hadith. Among Muslims, knowledge of a plant being mentioned in the Quran is often sufficient to validate its medicinal use [62]. Some medicinal plants cited in interviews are mentioned in the ‘the Medicine of the Prophet’: helba (Trigonella foenum-graecum), haba sawda (Nigella sativa), safarjil (Cydonia oblonga), rashad (Lepidium sativum), hana (Lawsonia inermis), zanajabil (Zingiber officinale), sana (Senna alexandrina), khull (Ammi visnaga) and sabr (Aloe vera), according to the list provided by Al-Yahya [63]. Of these, only safarjil (Cydonia oblonga) had not been documented already in the Saudi Arabian medicinal plant literature, which indicates a widespread influence of the Hadith in traditional Saudi Arabian medicine both in urban and rural environments. Moreover, the common use of mixtures among the research participants matches the recommendation made in ‘the Medicine of the Prophet’ that ‘city dwellers’ require the use of compound drugs (according to Deuraseh [39]). Specific modes of administration recorded among women in Mecca are also recommended by prophetic medicine [37], specifically the use of food, milk, honey and dates as excipients. This further evidences the influence of Islamic medicine in lay medicinal plant use.

Dynamic female knowledge

As in other Islamic countries, Meccan women are responsible for dealing with most health issues within the household and their medicinal plant knowledge is gender-specific. Gynaecological problems were frequently mentioned and toxicology and remarks about side effects often concerned women’s reproductive or children’s health, which are all references to gender-specific knowledge.

Meccan women may learn about medicinal plants from their family and social networks, but increasingly, written sources and mass media are becoming important sources of knowledge. This, along with a higher preference for biomedical services amongst the younger generation, could result in the erosion of medicinal plant knowledge. Ethnobotanical knowledge erosion has been observed in the Middle East both among herbalists [43] and the general population [36]. The diffusion of non-local knowledge about medicinal plants through mass media is characteristic to urban settings [64] and has a homogenizing effect on oral pharmacopoeias [65]. Mass media often disseminates information on the uses and properties of commercial plants, increasing their visibility [66] and, alongside availability factors, could also contribute to explain the high proportion of food and spices used among the Meccan women interviewed.

Mass media is also used in Saudi Arabia to communicate biomedical education programs [34]. Although these campaigns may be necessary, they favour biomedical knowledge over traditional therapies. Loss of ethnomedicinal and ethnobotanical knowledge may result from different treatment preferences between generations. Higher preference for biomedical treatments among younger Meccan women reflects the same trend among rural Arabic populations elsewhere in Saudi Arabia [36, 43, 58]. Although Press [2] argues that the disregard of faith and the role of family in biomedical diagnosis and treatment are often sufficient to hamper the utilisation of biomedicine, Ghazanfar notes that in the Arabian Peninsula, ‘modern and traditional medicine may be tried [simultaneously], or if one fails the other will be tried – but where modern medicine achieves results, traditional medicine tends to disappear’ [36, p. 1]. Biomedicine in Islamic countries integrates faith and has a religious viewpoint on caring [38], but people may still prefer home remedies for treating minor ailments [30, 36] as observed in this study. Even when biomedicine is growing and herbal remedies may be in decline, medicinal plant use still plays an important role in urban health care [2, 29, 30].

Conclusion

We join Emery and Hurley [67] in highlighting the vibrant botanical knowledge and practices in urban areas. Women in Mecca are the primary household health carers and hold a singular, lay body of medicinal plant knowledge to treat mostly common ailments. Plant availability in shops and markets, as well as religious texts, seem to play an important role shaping the urban medicinal flora of women in Mecca; we highlight the important medicinal role in urban environments of foods, spices and traded plants in general. Much of this knowledge had not yet been documented, and gender and geographical biases in research may account for the under-representation of urban women’s knowledge in Saudi Arabian medicinal plant literature.

However, medicinal plant knowledge among Meccan women may be eroded and changed with the spread of new knowledge through mass media and preference for biomedical care. Documentation efforts are urgent for the preservation of the diversity of medicinal plant knowledge in the Arabian Peninsula. We propose that scientifically rigorous ethnobotanical and ethnomedicinal research ‘acknowledging the sociocultural heterogeneity within the community being researched’ [32, p. 242] in Islamic settings can be achieved by teams with both female and male ethnobiologists. Al-Sodany et al. [41] have reported that medicinal plants in rural Saudi Arabia are vastly under-documented, but so far, ethnobotanical enquiry of women’s medicinal plants has been even more overlooked.

Abbreviations

MW: 

Meccan women

NA: 

Not available

Declarations

Acknowledgements

We are truly thankful to the 32 adult women who participated in this study and for sharing their time and knowledge. The authors would like to thank the members of the Umm Al-Qura University Herbarium and the University of Reading Herbarium (RNG) for their collaboration and support, especially Professor Kadry Abdel Khalik in the Umm Al-Qura University for validating plant identifications. We would also like to express our gratitude to the two anonymous reviewers whose comments helped improve the original manuscript.

Funding

This research has received support of the Saudi Arabian Cultural Bureau (SACB; Reference U590, Beneficiary: Afnan Mohammad Hazim Alqethami). During this research, researcher I. Teixidor-Toneu was funded by the European Union's Framework Programme for research, technological development and demonstration under grant agreement no. 606895.

Availability of data and materials

Herbarium specimens are available in the herbarium of the Umm Al-Qura University (Mecca, Saudi Arabia). All datasets on which the conclusions of the paper are based are made available as Tables 1, 2, 3 and 5 in this manuscript.

Authors’ contributions

AA contributed to the conception and design, acquisition of the data, plant identification, analysis and interpretation of data and writing of the manuscript; JAH contributed to the conception and design, interpretation of the data and writing of the manuscript and IT-T contributed to the conception and design, analysis and interpretation of the data and writing of the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Ethics approval was obtained from the Ethics Committee of the School of Biological Sciences, University of Reading (Research Ethics Project Submission SBS15-16 11), and all participants freely consented to participate after being informed of the aims and methods of the project, as mentioned in the “Methods” section.

Consent for publication

Consent for the publication of this study was obtained verbally from all research participants. The manuscript does not include personal details, images or videos of the research participants; hence, a consent form has not been submitted.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Section of Ecology and Evolutionary Biology (EEB), Harborne Building, School of Biological Sciences, University of Reading
(2)
Department of Biology, Faculty of Applied Science, Umm Al-Qura University

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