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Ethnomedicine in Pakistan

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Ethnomedicine refers to the study of traditional medicine based on the bioactive components within the plants, animals, and insects of a region. Various ethnic groups practice ethnomedicine, especially when they are unable to easily access Western and allopathic medicine. In many developing nations, traditional medical healers and herbal medicinal remedies are the primary course of treatment.

Pakistan is a country located in South Asia which is a diverse blend of South Asian, European, and Middle Eastern cultures. It is the fifth most populous country, exceeding 212.2 million people. Pakistan has borders with India on the east, Afghanistan on the west, Iran to the southwest, and China to the northeast. The geography of Pakistan is diverse, including deserts, forests, plateau, and coastal areas. Pakistan is multi-cultural and multi-ethnic, and the natural landscape, flora, animal species, and peoples have inspired various traditional practices which are utilized by the indigenous people to this day.

67% of the population lives in rural areas and 33% lives in urban areas[1]. For those living in the rural areas of Pakistan, ethnomedicine is the primary and preferred course of treatment, as these practices are considered to be safer, cheaper, and easily accessible to all. The dominant traditional medicine system in Pakistan is the Unani system, however it is noteworthy that many elements of the Pakistani traditional medicine system are shared with the Ayurvedic and Indian traditional systems.

Medicinal Plants

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There are approximately 6000 wild plant species which naturally grow in Pakistan[2], and of those, 600-700 are used medicinally. The use of medicinal herbs in South Asia can be traced back for thousands of years, especially their use in the Ayurvedic and Unani systems of medicine.

Withania Somnifera (Ashwagandha)

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Withania somnifera, commonly known as the Ashwagandha plant, a revered plant in traditional medicine

Ashwagandha is from the family Solanaceae, and is native to South Asia, Africa, and the Mediterranean. It is commonly referred to as the "Indian Ginseng", and its use can be traced back to 6000 BC, where its medicinal properties were applied to relieve stress, improve concentration, and enhance ones' energy levels[3]. In ancient times, it has been prescribed as a nervine tonic, as it is therapeutic to the nerves.

Ashwagandha has an anxiolytic and mood stabilizing effect. Research shows that it is comparable to the drug Lorazepam in all three standard anxiety tests[4]. It also has antidepressant capabilities comparable with the drug imipramine (Tofranil)[4]. Ashwagandha increases longevity and improves cell-mediated immunity[5]. The paste formed from the roots can be applied on the joints to alleviate joint inflammation and rheumatism[6]. It can also be locally applied to sores, ulcers, and wounds. The leaves of ashwagandha are recommended in fever and swellings. The flowers are astringent, depurative, diuretic, and also serve as an aphrodisiac. In its crude form, ashwagandha is a powerful anti-stress agent, and is scientifically shown to prevent stress induced gastric ulcers[7][8]. Ashwagandha aids in the inhibition and reduction of tumor growth[9], and is shown to improve white blood cell count and function.

The alkaloids within the ashwagandha plant have analgesic, anti-hyperglycemic, and anticancer, and antibacterial effects[10]. Alkaloids are stimulative to the central nervous system, and are neuroprotective[10]. They can be effective in treating epilepsy, psychological disorders, cerebral ischema, dementia, and memory impairment[10]. The sitoindosides VII-X and Withaferin-A contribute to the anti-stress capabilities of Ashwagandha[11]. Withanolides are also present in ashwagandha, and are evidenced to fight inflammation and tumor growth, treat chronic diseases, and have minimal side effects[12].

Zingiber officinale, commonly known as Ginger, a powerful medicinal plant and flavoring agent

Zingiber officinale (Ginger)

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Ginger is a powerful medicinal plant from the family Zingiberaceae, and its native region is in Southeastern Asia. Ginger is utilized as a flavoring agent in a plethora of dishes in Asian cuisine, and is proven to have many health benefits.

Ginger is used to promote digestive health, and has utilizations to treat nausea resulting from chemotherapy, motion sickness and surgery, and treats many gastrointestinal issues as well[13]. Ginger roots contain high levels of total antioxidants[14]. Ginger is also a powerful anti-inflammatory agent, and can treat inflammatory conditions such as joint problems and arthritis[15][16]. Many upper respiratory tract infections, coughs, and cases of bronchitis can be treated with ginger. Additionally, the fresh juice of ginger treats skin burns. Ginger has a warming effect on the body, which is why it is a good antiviral agent for the cold and flu[17]. Additionally, it boosts ones circulation and lowers high blood pressure.

Ginger contains over 400 different types of compounds, including carbohydrates, lipids, terpenes, phenolic compounds. Terpenes are also found in cannabis, and these components are found to have mood stabilizing, calming, and pain relieving effects. Additionally, gingers' phenolic compounds, gingerol and shogaol, are evidenced to be cytotoxic to many cancerous cell lines[18]. Research shows that 6-gingerol induces apoptosis of gastric cancer cells, as well as many other cancerous cell lines[19][20]. 6-gingerol is also proven to inhibit tumor production in mouse skin[21]. Additional research evidences that 6-shogaol and 6-gingerol have anti-invasive properties against hepatoma cells[22]. Ginger also contains amino acids, raw fiber, ash, protein, phytosterols, vitamins, and minerals[23]. Vitamin A is contained in ginger, and it supports a healthy immune system, reduces the risk of acne, has anti-carcinogenic properties, and has positive effects for vision health, protecting eyes from age related decline. Nicotinic acid (niacin) is also included within the chemical constituents of ginger, and it removes cholesterol deposits from the artery walls. Niacin is evidenced to prevent heart disease and symptoms of arthritis.

Dicliptera bupleoroides

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Dicliptera bupleuroides is from the family Acanthaceae, and its native range is from Afghanistan to South Central China and Indo-China. It is utilized as a natural remedy for diabetes, because the leaf extracts are evidenced to lower the blood glucose level. Results show that the leaf extract from D. bupleuroides were as efficient as the standard drug metformin, which is an anti-diabetic pharmaceutical medication[24]. The triterpenoids and flavonoids within D. bupleuroides have anti-oxidative properties which enhance ones' immunity to disease. Triterpenoids have anti-carcinogenic efficacy, anti-inflammatory capabilities, are anti-diabetic, and regulate the immune system. The sterols within D. bupleuroides have properties that lower cholesterol levels, which prevents heart disease and heart attacks[25]. Preliminary research shows plant sterols also have anti-cancer properties[26]. Additionally, D. bupleuroides has anti-fungal and antimicrobial properties. Alkaloids are present within this plant as well, which have analgesic properties and are anti-inflammatory as well as antimicrobial. The tannins within D. bupleuroides are shown to have anti-carcinogenic and anti-mutagenic properties, fight against harmful bacteria and fungi, and remove harmful microbes from the body. Research also shows that D. bupleuroides is non-toxic and has no side effects[27].

Achyranthes aspera

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Achyranthes aspera, commonly found as a weed on roadsides, has many medicinal properties and grows throughout the tropical world

Achyranthes aspera is from the Amaranthaceae family, and grows throughout the tropical world. It is commonly found as a weed on roadsides, and is referred to as "Chirchita" in Urdu and commonly known as the "prickly chaff flower". The dried leaf, flower, and seed extract of A. Aspera have anti-parasitic capabilities[28]. The alcoholic extract of the roots exhibits anti-inflammatory activity, and has bronchoprotective, cancer preventative, anti-allergic, and wound healing activity[28]. Notably, Achyranthes aspera also has spermicidal capabilities, and has been used as an effective form of birth control. Achyranthes aspera also is used to enhance gynecological health in women and treat various relating disorders[29]. Traditional healers state that the addition of A. Aspera will enhance the efficiency of any drug or plant.

Achyranthes aspera contains triterpenoid saponins, which possess oleanolic acid. Triterpenoid saponins prevent acne and sebum manifestation. Saponins are insecticidal, antihelminthic, anti-bacterial, anti-fungal, and exhibit antiviral capabilities. Ecdysterone is also included in Achyranthes aspera and is an insect moulting hormone which increases protein synthesis in human skeletal muscle. Ecdysterone has anabolic properties, which are tissue building, and they are contained in many popular athletic supplements[30]. The long chain alcohols which are found in this plant trap water to soothe the skin, which may explain the wound-healing properties of Achyranthes aspera.

Cinnamomum tamala, commonly known as the Indian Bay Leaf, or tejpat, is a common flavoring agent in Asian cuisine with various medicinal properties

Cinnamomum tamala (Bay Leaf)

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The bay leaf is from the family Lauraceae, is native to Asia Minor, and spread to the Mediterranian and other areas with similar climate. It has been used as a spice in food, and as a medicinal herb, since ancient times. The bay leaf has many proven medicinal properties which alleviate and prevent a plethora of disorders and ailments[31]. The leaves and bark contain qualities which alleviate pain and inflammation for rheumatism, colic, diarrhea, nausea, and vomiting[32][33]. The leaves have capabilities to reduce body weight, liver weight, and visceral fat[34]. Dried leaves and bark are prescribed for anemia, fever, and body odor[35][36]. The Bay Leaf also exhibits wound healing activity[37] and antioxidant activity[35].

Tejpat oil is the essential oil derived from the bay leaf. It is used to treat cardiac disorders[38], promote digestive health, and research shows it is therapeutically effective against Alzheimer's disease, diabetes[39], arthiritis, cardioprotective and neurological disorders. Research shows that the bay leaf is effective in fighting human breast cancer cells. The root essential oil of C. tamala is toxic to mosquito larvae and fire ants[40]. The leaf and bark oil is an antioxidant and anti-inflammatory agent[40]. The seeds of C. tamala have been crushed and mixed with honey and sugar to treat children with cough and dysentery.

The polyphenols within the bay leaf have antioxidant, anti-inflammatory, anti-diabetic, antimicrobial, and anticancer effects. The leaves contain many nutrients such as manganese, iron, dietary fiber, and calcium. The cinnamtannin and Tannin B1 within bay leaves have properties that aid in the treatment of type 2 diabetes mellitus and insulin resistance[39]. Bay leaves also contain vanillic acid, which is a phenolic acid that acts as an antioxidant, helping to repair DNA and cell damage that usually leads to cancer and Parkinson's disease[41]. The phytosterols within bay leaves have cholesterol lowering properties. Saponins decrease blood lipids, and affect the immune system in ways that protect the human body against cancers.

Lawsonia inermis, commonly known as Henna or Mehndi, is a plant that has been used since ancient times for its medicinal and cosmetic properties.

Lawsonia inermis (Henna / Mehndi)

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Lawsonia inermis, also known as henna or mehndi (in Urdu) is from the family Lythraceae, and is native to Northern Africa, Asia, and Australia. It has been used since the ancient times, as Cleopatra was said to use henna for decorative purposes. People living in the desert used to apply henna paste to cool the body[42].

Henna has a cooling effect on the nerves when applied as a paste on the body. Because of this, henna is effective in treating arthiritis and inflammatory conditions, and headaches from the heat of the sun. Various skin conditions such as burns, wounds, and eczema can be treated with henna. Fresh leaves are antimicrobial as well as antifungal, and can be used as a topical antiseptic for fungal and bacterial skin infections, such as ringworm[43][44]. Henna is shown to have an antimicrobial effect on a wide range of bacteria[45].

Henna is known for its role in promoting hair health. It seals the hair cuticle, prevents breakage, increases the shine and appearance of hair, and decreases dandruff. Henna is also a natural hair colorant, and does not cause irritation of the scalp[46]. which also kills head lice[47].

Coumarin, a chemical compound found in henna, is effective in treating lymphedema, and increases levels of antithrombin in the body. Additionally, coumarin has antioxidant and anti-inflammatory capabilities, which inhibits cell damage[48]. Naphthoquinones are also found within henna, and these compounds are cytotoxic, antibacterial, antifungal, antiviral, and insecticidal[49]. Research shows that naphthoquinones benefit the cardiovascular and reproductive systems[50]. Flavonoids in henna protect the body against toxins and stressors, as they are great antioxidant agents. Sterols within henna lower cholesterol levels, prevent diseases of the heart, and have anti-cancer properties. Tannin, also found in henna, is known to remove harmful microbes, bacteria, viruses and fungi, which explain hennas antiseptic and antibacterial properties. Additionally, tannins have anti-carcinogenic and anti-mutagenic properties[51].

Curcuma longa (Turmeric)

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Turmeric powder, from the plant Curcuma longa (turmeric) is a flavoring agent in South Asian cuisine with powerful medicinal properties

Turmeric is from the family Zingiberaceae (ginger family) and is native to tropical South Asia. It has been used by traditional healers for thousands of years. It has antioxidative, anticancer, antimicrobial, and cardioprotective properties, which make it a powerful natural remedy in fighting chronic diseases. South Asian cultures have used turmeric for centuries as a natural flavoring agent in cuisine, and as a natural remedy for various ailments. It can be applied as an antiseptic for cuts, burns, and bruises because it is an antibacterial agent[52]. Turmeric is used as an anti-inflammatory agent[53], a remedy for arthritis[54], gastrointestinal discomfort, and a treatment for IBS and other digestive issues[55][56]. Clinical studies have been conducted which have proven that turmeric treats peptic ulcers[57]. In Pakistan and Afghanistan, it is used to cleanse wounds and stimulate their recovery through application on a piece of burnt cloth which is placed over the wound[58]. Turmeric oil is effective in treating various respiratory conditions, asthma, and relieving the cough[59]. Turmeric is also utilized to treat liver disorders, anorexia, rheumatism, runny nose, cough, and sinusitis. It has antioxidative[60], anticancer, antimicrobial, and cardioprotective properties, which make it a powerful natural remedy in fighting chronic diseases. In South Asian cultures, there is a tradition called the Haldi ceremony, where turmeric paste to a bride's skin to make it glow and remove any harmful bacteria from the body.

Curcumin is the chemical constituent within ginger which is responsible for the bright yellow color, and has powerful antioxidant effects. Eucalyptol has anti inflammatory and antioxidant capabilities in various diseases and illnesses : colon damage, pancreatitis, and neurodegenerative, respiratory and cardiovascular diseases[61]. Zingiberene, which is also found in ginger, has anti-inflammatory, antioxidant, cholesterol-lowering, and chemopreventative properties[19]. The terpinene found in turmeric has antibacterial and antimicrobial properties[62]. Turmeric rhizomes contain carbohydrates (69.4%), protein (6.3%), fat (5.1%), and minerals (3.5%)[63]. Turmeric's anti-inflammatory and antioxidant capabilities allow the paste to give a shine and 'glow' to the skin. Research has proven turmeric's anti-carcinogenic properties : ar-turmerone, when isolated from turmeric, is effective in inducing apoptosis in human leukemia cell lines[64].


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