Ethno-medicinal survey of important plants practiced by indigenous community at Ladha subdivision, South Waziristan agency, Pakistan

Background Medicinal flora plays a vital role in treating various types of ailments in living beings. The present study was planned to investigate and document systematically the indigenous knowledge in a scientifically little explored area of Ladha sub-division, South Waziristan agency, Pakistan. Hence, this study would contribute positively to the field of ethnopharmacology. Methods Prior to ethnomedicinal data collection, regular field visits were conducted during the month of May and June 2015 to locate the sites and respondents from where the traditional knowledge was to be recorded. Ethno-medicinal data was collected during the month July and August 2015 through rapid appraisal approach (RAA) based on direct interaction with the indigenous communities by making group discussions, corner meetings and semi-structured interviews. Data was evaluated statistically by using the index of Use value (UV) and Frequency of citations (FC). Results A total of 82 medicinal plants belonging to 42 families were reported in the study. Leaves were the most frequently used plant parts. Highest use values were recorded for Peganum harmala (0.93), Punica granatum (0.91), Thymus mongolicus (0.90), Chenopodium album (0.89), Coriandrum sativum (0.87), Mentha longifolia (0.87), Lactuca serriola (0.87) and Portulaca oleracea (0.87). Medicinal plants used for the gastro intestinal complexities and respiratory diseases were more than 9% followed by skin and diarrhea (7% each), liver disorders (5%) cough and cold fever (5%). Conclusion People of the area mostly still rely on traditional herbal therapies. Keeping in mind the dependence of the indigenous community for their primary health care on such herbal remedies, pharmacological and critical toxicological investigation of certain flora is necessary. Moreover, projects should be designed to analyze the existing issues and problems related with medicinal plants conservation.


Background
Documentation of ethno-medicinal information have substantial role in illuminating folk knowledge, which facilitates the discovery of modern allopathic drugs [1,2]. In modern pharmacopoeia, several synthetic drugs of plants' origin have been documented. Currently in the developing countries, about 80% of the world's populations rely on these traditional therapies to cope with several ailments [3][4][5]. Medicinal plants comprising of several biologically active factors [6]. Varieties of therapeutically active plants are used in herbal medicines, and have proved their efficacy to compete with the modern allopathic drugs [7]. Out of the total 265,000 flowering plants species [8], only a small proportion (5000 species) has been analyzed for their biological potential [9].
In Pakistan, traditional uses of of medicinal plants has been documented from many areas [10][11][12][13][14][15][16] but still in remote areas (including tribal areas) there is scarcity of reports, in which the folk knowledge about the medicinal plants have been properly mentioned [17][18][19][20][21]. Local people of certain areas utilize plants for their health maintenance because of poorer economic values and lack of modern health facilities [22]. These traditional medicines have been used for long time but unfortunately these valuable knowledge has been not properly recognized and documented in many areas of the country especially in federally administrated tribal areas (FATA) including South Waziristan agency.
Ladha is the sub-division of South Waziristan Agency. The introduction of allopathic medicines has greatly affected the knowledge, faith and skill about the traditional herbal therapies in the study area. Apart from these, the territory is also under critical condition due to armed conflict and other terroristic activities for the last one decade. Consequently middle class sect prefers to migrate partially or wholly to settle areas where the chances of exposure to modernization became more prominent which ultimately has negative effect on the consistency of traditional knowledge, losing its originality and going to the periphery of extinction. That is why the present study was planned to investigate, catalogue and record the folk knowledge and ethno-medicinal values of the local flora at Ladha so as to preserve the Ethno-medicinal knowledge and share it with other communities.

Study area
The undertaken study was carried out in Ladha, being a part of Federally Administered Tribal Areas (FATA). The study area comprised of a mass of rugged and complex hills and ridges. The overall area of the agency is comprised of 6619 km 2 and is laying at 321 24′ 50″ N latitude and 691 42′ 06″ E longitude having 4100-7000 ft altitude. Temperature in the area falls to 0°C during winter at some places with higher altitudes where snow fall also occurs. The winter is extremely severe with coldest months of December to February. The average rainfall per annum is 6 in. while in plain areas the summer season is comparatively much hot. Ethnographically two tribes are the inhabitants of the area ie Mehsud and Barki. The Pashto language is used for the communication in the locality.

Socioeconomic status of the indigenous communities
The overall socioeconomic status of the indigenous communities is comparatively poor. The sources of income of these communities are different ie government servants, farmers, drivers while some have their own business. Most of the people manage their income from domestic and foreign remittances and forest products. In the study area, frequently the indigenous communities have cattle herds in their homes. The cattle are also a source of livelihood for most of the people. Almost half of the respondents, selected and interviewed were illiterate (50.44%), whilst most of those with an education had merely up to primary (29.09%) which reflects the unavailability of standard educational institution in the area (Table 1). It was also observed that the literate sect in the study area was less conversant with respect to traditional knowledge and uses of medicinal plants as compared to illiterate one. Those places which have no proper communication with advanced areas, people still depend on medicinal flora to treat and combat with disease. If the cultivation and sustainable use of medicinal flora are promoted in the area, it will positively affect the socioeconomic status of the indigenous communities.

Informant selection and ethno-medicinal data collection
Prior to ethno-medicinal data collection, regular field visits were made to locate the sites and to gather information about the respondents and their expertise in traditional knowledge. Being the local inhabitant, Mr. Muhammad Abdul Aziz was aware of those sites where there is a significant trend for the utilization of traditional herbal recipes in their daily routine for treating ailments. All the meetings and discussions were in local language ie Pashto. Meetings were conducted with the local representative (Malik) of the area to display the main theme and objective of the study. In the study area, Malik is considered to be the head of a tribe and is responsible for dealing the local matters. Without their recommendations, community involvement is not possible in such kind of field surveys and studies. The step was taken in order to acknowledge their co-operation and to develop the confidence about the provided knowledge so as to gain valuable information. Ethno-medicinal data collection was carried out in midsummer ie from May 2015 to August 2015. During the month of May and June, the local respondents were targeted for interviews, while the Ethno-medicinal data was collected in the months of July and August. As the area is covered by snow fall and the winter season is very cold in the territory, mostly the medicinal flora is blooming in the month of June, July and August. All the selected informants were reported to be highly conversant about the traditional therapies but most of the data was taken from the local healers.
Rapid appraisal approach (RAA) was conducted to collect the indigenous knowledge. Survey was based on direct interaction with the indigenous people through group discussions, corner meetings and semi-structured interviews following the method by Martin [23]. A total of 14 sites were selected for the study ie Karama, Malak Mella, Landay Karama, Sam, Kaniguram, Ashpashteen, Ladha, Mordar Alagad, Salwashtai, Zawar Klai, Shak Toi, Meeshta, Kacha Langer Khel, Speena Mella (Fig. 1). Overall 197 local informants were selected as information provider belonging to different age groups in which 128 were male and 45 were female while 24 were local healers (Hakims) ( Table 1). The interviewed persons were reported to be experts in the field of traditional medicines with high status in the indigenous community but most of the data was recorded from the local healers. The informants were belonging to different professions like farmers, rural herbalist (Hakeems) and housewives. To ensure the strong validity of traditional knowledge, continuous relationships were maintained with the local peoples throughout the duration of the whole survey.

Preservation and taxonomical verifications
Medicinal plants mentioned in the current survey were collected and identified by a taxonomist at the Department of Botany, Kohat University of Science and Technology. The plants were pressed for dryness, poisoned (1% HgCl 2 solution) and were mounted on herbarium sheets. Voucher number were assigned, submitting them to the department of Botany at Kohat University, for future references by matching them for verification with the flora of Pakistan [24,25].

Data organization and analysis
Data compilation was carried out in MS Excel. Frequency of citation mentioned by the informants was counted for each specie. Phillips and Gentry [26] introduced the idea of relative importance of a plant through calculating the index of use value. Following is the formula for calculating use value. Use value for specie x; Where U x is the number of use reports described by each informer for specie x while N is the total number of informers describe the specific specie x.

Traditional knowledge and informant demographic status
The utilization of medicinal plants to combat with various ailments is as old as human civilization. It has been reported that about 20% of the whole plants found in this world are used for medicinal purposes to treat ailments in living beings [16]. In the study area, several herbal traditional recipes have been used by indigenous communities especially by the local healers, having significant role in the local health care system. They use the medicinal flora as the first aid in curing any ailment except in severe emergencies just like other parts of the country [27]. Present exploration has reported valuable traditional information about the medicinal plants from an area which is very little explored in the tribal belt of Khyber Pakhtoonkhwa [28]. Current study observed a significant decrease in the skill, faith and knowledge about traditional herbal medications due the recent introduction of allopathic medicines. Similar results were found by Sher et al. [29] in a study conducted in district Chitral. Our findings can also be justified by the other similar studies conducted earlier which have clearly shown the erosion of the precious knowledge due to modernization [1,28,30,31]. Furthermore in the study region, the important medicinal flora faces some threats such as heavy grazing, uncontrollable cutting, deforestation and the collection these plants for fodder purposes by the local collectors. Similar findings were also reported by [32]. It has been reported that due to the change in socioeconomic pressure, the traditional knowledge about the folk herbal medications is slowly and gradually going towards extinction [33,34]. Table 1 shows the demographic information of respondents while Table 2 provides the local names, part used, medicinal description and the use value of the reported plants species. A total of 197 respondents were interviewed. Medicinal knowledge was obtained from 113 while the rest of the informants were interviewed to locate the experts having the traditional knowledge in every village before conducting the ethno-medicinal survey. Informants were grouped into various demographic categories. Male informants were mostly interviewed because in the area female informant is not allowed to conduct an interview with male informant. The concept of gender segregation and veiling (Parda) is predominant in the area and according to them this is based on their religious tradition as also reported by Ahmad et al. [35]. Most of the data was gathered from the local healers (Hakims) and elder members of the community who possessed comparatively more accurate and sound traditional knowledge about the parts and recipes which improve the effectiveness of medicinal plants. That is why that the traditional herbal recipes prepared by the elder community members (traditional practitioners and collectors) are more effective then prepared by the younger ones [36,37]. This may be attributed to the recent trend towards modernization, affecting the level and accuracy of information which transfer from generation to generation [38]. If the trend is continued for some time then it will result in the gradual disappearance of the traditional folk knowledge and will delink the current relationship between plants and human. [28]. The decreasing rate of transfer of indigenous knowledge might be due to the fact the younger generation is not taking an interest in the learning and practicing the knowledge because the indigenous societies are exposing to modernization more and more day by day [28]. While conducting the survey it was also observed that the illiterate members of the communities were more aware of the traditional knowledge as compared to educated ones. Comparatively, highly educated persons were found to be less conversant about the traditional knowledge and medicinal plants uses. Same findings were also observed in the different studies conducted in Pakistan   depression, insomnia and depression due to its sedative and analgesic effects.
Abdominal pain is also treated with the herb. the plant is also ant helmentic and is effective in the treatment of liver disorders, jaundice. The young shoots of the plant is soaked in a glass of water for 3-5 h and then the filtrate is used orally to treat kidney pain. To remove the kidney stones, half glass of the above filtrate is mixed with equal amount to the extract of corn hair and is taken orally.  To lower the blood pressure and to treat the leucorrhea, rhizome of the plant is used. The rhizome is also used as a source of tonic and also helps in treating rheumatism.    [39] Thailand [40] and Ethiopia [41,42]. Findings of the current study suggest that the knowledge of traditional medication is in scattered form which is to be compiled and arranged in a systematic way so as to release the knowledge from the custody of local healers and older people and to share with the other communities through published literature. No doubt those local healers and the older people in the remote areas have sufficient knowledge about the uses of medicinal plants but still they are unaware of the importance of such traditional knowledge. Special initiatives and awareness programs and projects should be designed to make fruitful strategies so as give awareness to the local communities about the importance of medicinal flora and also the importance of medicinal flora.

Medicinal flora and its relative importance
Phillips and Gentry [26] introduced an index to calculate the relative importance of a species in term of its traditional use. This quantitative technique helps in authenticating and projecting the relative importance of species or the whole family. Different plants species showing various values in term of their use value index (Table 1).
In this investigation, high use value was recorded for

Medicinal plants uses
The present study reports 82 medicinal plants species utilized by the indigenous people in the investigated area. The reported medicinal plants obtained during the current survey were belonging to 42 families and 66 genera. Most frequently used plant's parts were leaves followed by fruit (18%), whole plant (18%), seed (12%) and so on (Fig. 2). Many studies conducted in different ethnic communities, have reported frequently the use of leaves in traditional therapies [43][44][45][46][47][48][49][50] and the widely accepted role of leaves in traditional herbal medicines may be due to large quantity of biologically active components present inside them [51]. The consumption and harvesting of leaves and other aerial parts from medicinal plants is much better than the root for the maintenance of the specie [52]. Apart from leaves, almost all the other parts of medicinal plants such as flower, bark, stem, seed fruit are also used but the collection of that specific part depends on the requirement of the user and type of the plant species. The utilization of leaves in traditional medication may also be due to their easy availability, processing methods and minimum conservational issues [53]. Medicinal plant with multiple medicinal uses work as a strong indicator to highlight the presence of biologically active therapeutic components and other phyto-constituents and these observations and findings and such findings may prompt further research into their medicinal application [28]. Those parts of the plants which are frequently used may suggest and highlight the fact that these part may have strong medicinal values and need to further evaluate and analyze them biochemical screening and pharmaceutical evaluation so as to cross check the local and indigenous information.
The study indicated the use of several medicinal plants against specific diseases or category of diseases. Reported medicinal plants were used against 33 different kinds of diseases including some serious ailments like cardiac problems, hepatitis and sexual problems. Medicinal plants used for the gastrointestinal complexities and respiratory diseases showed a high incidence (9%) followed by skin diseases (7%), diarrhea (7% each), liver disorders (5%) cough and cold (5%) and so on (Fig. 3). These results indicated that the gastrointestinal problem is the common diseases occurring with high frequencies.
Furthermore these gastrointestinal problems are not only common in the study area but is a common concern of the whole country [28] resulting in the higher mortality ratio if the diseases are not treated promptly and quickly [54].
Indigenous current exploration has also found the over collection of two most important economical valuable species ie Caralluma tuberculata and Nannorrhops ritchiana [55] which have the capacity to cultivate [56] so as to restore their ecological role and because these two taxa are under great threat due to their over consumption. In a study conducted by Adnan et al. [28] The same species were recorded with facing the same threats.
Current investigation recorded the recipes in the form drying and macerating into powder, boiling as tea, juicing and pulsation into paste are the common administration methods observed in the study area. (Table 2) [28]. Deeba [57] reported that grinding or crushing and boiling as tea are the most common and efficient methods for the extraction of active ingredients. During the survey it was mentioned by the traditional healers that the use of complex medicines which is formed by the combination of two or more plant parts is more potent medicinally as compared to the medicines which is prepared from single plant species which is an agreement with the findings of [58]. The use and better efficacy of those recipes which are formed from more than one medicinal plant can be attributed to the synergistic or additive effects [59]. The way which is adopted for the preparation of drug differ from individual to individual in which the same plant material is prepared in different way for the same ailment. For example, the aerial parts of Peganum harmala are used against colic pain, jaundice, asthma, spasm and as narcotic. The decoction is made from its seeds is used for the treatment of laryngitis (Table 2). These findings are running parallel with the findings of the study conducted by Ullah et al. [31] in which the same ailments were treated by the plant but instead of aerial parts, fruit was used. Fruit of Punica granatum is used to overcome the iron deficiency. For nasal congestion, the bark of the plant is used. Epicarp of the fruit is dried and is given to cattle for treating diarrhea (Table 1). Kayani et al. [39] reported the uses of Punica granatum powdered form, prepared from fruit, bark and leaves for the treatment of whooping cough from Gallies, Abbotabbad, Pakistan. Similarly in the study the Thymus mongolicus, is used as carminative, tonic and antispasmodic. It improves poor vision. It is also used for stomach and liver problems also suppress urine and mansturation. Seeds of the plant are used as vermifuge. Farooq et al. [60] reported the uses of Thymus mongolicus as antispasmodic, carminative, tonic and is given in weak vision, complaints of the stomach and liver, suppression of urine and menstruation. Chenopodium album is as diuretic, aphrodisiac, appetizer and used as tonic. Abdominal pain is also treated with the herb. the plant is also anthelmintic and is effective in the treatment of liver disorders, jaundice. Decoction of young shoots is used orally to treat kidney pain. In the current study Lactuca serriola is used as sedative, diuretic, diaphoretic, antispasmodic and expectorant. Findings about the medicinal uses of Lactuca serriola reported in our study are going parallel to the finding of Ullah et al. [31]. In the same way, study conducted by Kayani et al. [39] it was found that Lactuca serriola whole plant is used as expectorant and also utilized for the treatment of cough, phthisis, bronchitis and asthma. The similarities observed in the cross cultural uses of the traditional herbal remedies indicate the biological potential of the documented flora. To minimize the effect of the remedy's astringent taste, different liquids such as water, sugar, juices, oil are also mixed with the processed plants parts so as to avoid the bitter taste of the remedies. To minimize the relative potency of the recipe, different the above mentioned vehicles are used which further dilutes the drug [61].
Despite the fact that folk use the plants for several infections but except few medicinal plants species, most of the plants documented in the current investigation are not still analyzed for their detailed pharmacological potential. For instance Chenopoduim album has been screened out comprehensively for its phytochemical anthelminthic potential and further work is also in progress [62]. Khan et al. [63] investigated Peganum harmala for antimicrobial potential obtained from Margalla Hills, Islamabad. Antimicrobial activity of different plants' extracts of Datura stramonium have been evaluated for their respective potential, from the region of Khyber Pakhtoonkhwa, Pakistan [64]. Similarly Withania coagulans has been investigated pharmacognostically in detail by researchers [65]. Esra et al. [66] analyzed Cannabis sativa for its pharmacological potential against fungal and bacterial diseases and was found the best against the targeted diseases. But still there are varieties of medicinal plants such as Sophora mollis, Thymus mongolicus and Tulipa lehmanniana and so many others which need detailed pharmacological and critical toxicological studies in order to make safe and effective utilization of the herbal products. The discovery of new biological active constituents should be focused during such phytopharmacological investigations.

Conclusions
Ladha is a remote area where the local people still rely on traditional herbal therapies for their primary health care services. In the study area the traditional knowledge is in custody of elder community members and local herbalists. The study reports several important medicinal plants having significant contribution in the treatment of different diseases. Our study has a contribution in the documentation of traditional knowledge because the knowledge is losing its originality day by day due to exposure to modernization. The study highlights the need exploration of pharmacological, toxicological, phytochemical and microbiological studies of the reported medicinal plants to make the better and effective use of the plants. Present investigation highlights several threats including heavy grazing pressure, cutting activities, deforestation which affecting the sustainability and declining the population of the local flora. Apart from this the study area is suffering from terroristic activities and "War on Terror" is going on, which is also a great issue to be addressed. Research projects should be designed to analyze comprehensively the conservation status and threats to the flora in the study area. While designing research management plans and strategies, the existing ecological and other cultural matters should be documented and addressed.