Ethnomedicine and Traditional Health Care System of a Particular Vulnerable Tribal Group in India: Application of Plant Extracts

The exploration on association of between human and nature has made conceivable to comprehend the undercurrent lifestyle of the communities and the ecosystem in which they inhabit together. Over the last decade there has been a rise of ethnomedicinal studies, still small is known about use of ethnomedicine in traditional health care system of the Juang , which is one of the 75 particularly vulnerable tribal groups (PVTGs) in India. Traditional system is unique and undeniably an important cultural ingredient. The aim of the present study was to document the ethnomedicinal practices of the Juang , who live in forest fringes and hill tracks and derive their livelihood from forest-based resources. They used varieties of plant extracts, traditional knowledge and belief system for treatment as well as prevention of from various disease and ailments.


Abstract Background
The exploration on association of between human and nature has made conceivable to comprehend the undercurrent lifestyle of the communities and the ecosystem in which they inhabit together. Over the last decade there has been a rise of ethnomedicinal studies, still small is known about use of ethnomedicine in traditional health care system of the Juang, which is one of the 75 particularly vulnerable tribal groups (PVTGs) in India. Traditional system is unique and undeniably an important cultural ingredient. The aim of the present study was to document the ethnomedicinal practices of the Juang, who live in forest fringes and hill tracks and derive their livelihood from forest-based resources.
They used varieties of plant extracts, traditional knowledge and belief system for treatment as well as prevention of from various disease and ailments.

Methods
Besides questionnaire as a tool for data collection, Interview, observation (both participant and nonparticipant observation) and focus group discussion (FGD) were used. Field surveys were carried out in three phases. The informants were selected through the snowball sampling technique. Twelve males and two females key informants were interviewed. The study was exploratory and qualitative in nature.

Conclusions
Our study can be concluded that the Juang people are rich in indigenous knowledge and have provided novel information on the use of medicinal plants to cure, protect and prevent from various diseases and ailments, that are scientific in nature. The novel information has been generated in the present study which will through a light in the direction of modern medical science for the sustainability of human society and recognize the indigenous knowledge as well. We suggested that indigenous knowledge need to be documented and integrated with scientific knowledge to develop new health care management programme.

Background
The enquiry to understand the source and causes of any disease is an important health enquiry among the indigenous communities. Finding to this enquiry is thus important for prevention as well as cure through best possible use of knowledge and rationality is important practice among the forestbased communities and hill dwellers. Understanding of these practices in the context of cross-culture, is called "ethnomedicine" which also hold significance to modern health sciences, biology and the social sciences. Over the years, researches on ethnomedicine have originated new thoughts and applied their domain of knowledge to modern health sciences. The prime concern of ethnomedicine is the existing relationship between disease and environment (human adaptation and socio-cultural behavior), that how peoples of different racial groups look into the diseases and illness towards prevention and cure on the cultural and social organization perspective [1]. Ethnomedicine as specialization can be applied to examine the contemporary issues that has relevance to the biomedical system, as it elucidates how people of different cultural background deals with sickness and its consequence. The contemporary social issues help to understand: i) the effects of environmental factors on human physiologic functions [2], ii) etiological mechanisms of rare and isolated diseases [3], iii) pharmacologic influences of plants, herbs, and other medicines used by a native people [4] and iv) the role of symbols and persuasion in medical healing and in behavioral change [5,6]. It is believed that ethnomedicine can be utilized to prevent and control the consequence of disease and illness in a more rational way.
Ethnomedicine is a sub-field of medical anthropology that focuses on the nature and effects of diseases and illness. It is conceived by the natives, their own method and criteria for classifying disease, cure and cause, types of therapists and healers who seek to alleviate illness and their skills and social roles, preventive measures, the relationship between medicine and religion, cultural aspects of medicine [7]. Ethnomedicine refers to beliefs and practices relating to diseases which are the products of indigenous cultural development and are not derived from the conceptual frame work of modern medicine [8]. The practice of ethnomedicine is based on the traditional knowledge and belief system by using wide range of plant species extracts, for prevention as well as treatment of many disease and ailments. Since ancient time, use of traditional knowledge for ethno medicine in India has been documented [9]. It is reported that there are more than 43% [10] and 50000 [11] of   the total angiosperms or flowering plants have been used for medicinal purpose in India, where as there are 4,22,000 angiosperms reported throughout the globe [12].
Documentation of traditional knowledge on health care practices has directed the discovery of various kinds of valuable drugs used in the modern society [13][14][15][16]. Even now-a-day, in developing nations approximately 80% of the population dependant on the ethno-medicine are seeking for health care [17]. The concept of ethnomedicine according to Raji (a primitive tribe of Uttaranchal, India) is any deformities or disorder found on the body including delivery complications, boils, injuries that make a person incapable for performing normal activities is called diseases or illness. And they are consulting the local healer or folk medicine man known as ojha at the time of illness [18]. The utilization of ethnomedical system is predominantly prevalent among the Bhangalis (a tribe in western Himalya, Himachal Pradesh, India), which is clearly elucidated from the local saying that "a person cannot be died or succumb to disease in a region where medicinal plants such as Vitex negundo, Adhatoda vasica, Acorus calamus, Terminalia chebula, Terminalia bellerica, Emblica officinalis and Tinospora cordifolia are available for treatment" [19]. Every culture has its own belief, faith and practices concerning disease [20]. It is widely believed among tribal communities that, supernatural proxies or metaphysical entities are root cause of the disease or any deformities of health condition in any kind.
They believe that, there are many more types of supernatural power exist, among which three major kind of supernatural power are influencing the health status of the tribes in different ways. These are as follows: i) Benevolent spirit, ii) malevolent spirit and iii) ancestral spirit. The benevolent spirits are worshiped regularly in the family as well as at the community level; else it can cause death, disease or any physical injuries [21]. Secondly, the evil spirits who are controlling fever, abortion, small pox, etc. are worshiped as malevolent spirits [22]. And finally, genealogically inherited spirits from their ancestors, who are protecting them always in each and every adverse situation, are worshiped as ancestral spirit or protective spirit [23,24]. The feasibility and accessibility to avail the modern health care system among the tribal will determine the magnitude of acceptance rate of a particular health care system. And, tribal communities are stimulating indigenous knowledge for treatment by putting the value on religious or supernatural power with respect to ethnomedical system. However, organized studies in this direction were initiated off late have been recognized and the studies on such issues of ethnomedicine are gaining popularity. Unfortunately researches on ethnomedicine in Odisha with tribal population above one-fifth of total population did not pay much attention in this regard at the same time. Despite vast pool of resource available through ethnomedicine using plant and animal extracts among tribes in Odisha, there is hardly any literature on such vast resource pool available and also, there is lack of documentation of this practice in the state. Ethnomedicine which is associated with science (wisdom), culture and society has great potential to address common health concerns of the community. Ethnomedicine and traditional health care practices as alternative means to modern health care practices remain important among the Juangs who find it difficult to access modern health care facilities due to various social, cultural, geographical and economic constraints. It is important we must protect the indigenous knowledge system before it goes vanish due to cultural transition, integration and assimilation. Our possessiveness to modern medicine and ignorance to traditional wisdom and ethnomedicine may eventually lead to extinction of traditional health care as an alternative practice.
Keeping this in view, the present study was a modest attempt to examine the nature and application of plant extracts by the Juang tribe in Odisha as a part of the study concerning ethnomedicine.

Methodology
The ethnomedicinal survey was conducted among the Juang tribes in Gonasika area of Keonjhar district. This study is exploratory and qualitative in nature. Field surveys were carried out in three phases during 2019. In the first phase a pilot survey was conducted to establish the rapport and identifying the key resource persons to understand their dialect. Main survey was carried out for a period of three months, i.e., one month in each season of the year that includes summer, rainy and winter season so as to collect more information related to health and traditional health care practices.
In the end, a short field visit was carried out to cross check the information gathered during the earlier visits and also to ascertain the correct identity of plants and their distribution. The informants were selected through the snowball sampling technique that included traditional healers as well as elderly men and women having involved in this practice since childhood. The members are considered as repository of health wisdom and effective users of flora and fauna to cure various diseases. Twelve males and two females key informants were interviewed after getting verbal consent from them for the collection of data about the utilization of ethnomedicine in the traditional health care system. The traditional healers or the tribal medicine men who use the ethnomedicine are locally known as Topographically the district can be broadly divided into three divisions namely: i) Plain regions of Baitarani river belt, ii) Hilly region of Juangpirh and Bhuinyapirh, and iii) Mountain regions of western and northern part. Agriculturally the district is undeveloped as it is mostly rain fed and drought prevails most of the year. Paddy is the major crop grown in the district.

People Under Study
The Odisha province has a total of sixty two (62) distinct tribal communities (referred as indigenous people) out of which thirteen (13)

Results
It has been observed that, since the ancient time human and nature interlinked in many different ways. Though there has been an increase number of studies on ethnomedicine, still there is no record on the exact number of traditional healers in India. Undoubtedly, most of them live in rural areas.
These people use different plant parts or even the whole plant for the ethnomedicinal purpose through using the indigenous knowledge that plays a vital role in the traditional health care system.
The study explores that, dependence on plants and animals extracts still exits and about 25% drugs components derived from angiospermic plants [25,26]. It was found that, indigenous knowledge on the utilization of medicinal plants for the traditional health care system seems to not be confined among the vaidas or so-called traditional healers, where as it is spread across elderly people, Shaman, village headman of the tribal community as well. It is vividly observed that, younger generations are not much interested about utilization of ethnomedicine for traditional health care system in the contemporary scenario, which might be the one of consequence of rapid industrialization, migration to cities, and access to technology and social media about the contemporary social issues. The report of the finding represents a total of 38 plant species belongs to 26 families as having ethnomedicinal uses in the traditional health care practice among the Juang community. The following information was provided for each species, like vernacular name, scientific name, uses in treatment of disease, dosage and plant parts used in table 1. In all, from the study area the Juang community uses 38 plants for treating various diseases, out of which highest number of plants belong to tree followed by herb, shrub and small tree as shown in Fig. 2.
In most of the cases, comparatively leaf part of the plants utilized frequently for medicinal purposes followed by root, seed, bark, fruit, rootstock, tender twig where as stem, flower, whole plant, inflorescence, prop root, tuber, anther, root bark, Petals and latex are less utilized as shown in Fig. 3.
These medicinal plants were used for treating the common ailments such as cold, cough, fever, stomach ache, head ache, wound, burn, skin disease dysentery etc. At the same time the medicinal plants were utilized to cure various highly complex diseases like malaria, diabetes, jaundice, and asthma, as well as male and female disorders included (Fig. 4).
The mode of preparation and administration of the medicinal plants were of various kind of form that included paste, juice, powder, oil, crushed, concentrated liquor and whole plant extract. It was found that some plants were used in more than one form of mode of preparation. In many cases it has been observed that a single plant is utilized for treating many different types of diseases and the pellet constitutes a combination of a number of plants and different part of plants. The ingredients of the pellet were in combination of different plant and animal extracts, and some minerals, oil, milk, salt etc. or used singly either. These medicines were prepared using different methods which includes roasting, frying and drying in the sunlight and boiling with water and crushing with specifically tools.
Sometimes the traditional healers have to go into the dense forest passing through narrow passages on hills and plains for collection of the medicinal plants, however, majority of the medicinal plants are found in the forests nearby their settlements. practices, which is firmly accepted by the World Health Organization [27,28] and World Bank [29]. In literature of ancient medicine system of India, which includes Ayurveda, Sidha and Unani: there is most focus on use of plants and processes for use as medicine. This has closely relevance with the ethnomedicine that can be elucidated from the present study. The plant species Hemidesmus indicus is used for treating jaundice, fever and rheumatic pain by the Juang tribes, which is also find prescription in Ayurveda for curing skin disease, cough and rheumatism [30]. In others study it was found that Aconitum heterophyllum is used by the Bhangalis for curing stomach ache finds mention in Ayurveda for curing stomach ache and fever. It is one of the main ingredients of "Ativishadi churna", "Chandraprabha vati" and "Amritarishta" ayurvedic medicines [31]. Similarly, the plant species Abrus precatorius that is used by the Juang people to cure leucorrhoea, rheumatic pain and for abortion in early stage of conception, are also found to be used to treat leucoderma, tetanus, and rabies by some communities [32]as well as to treat ailments, such as scratches, sores, and wounds caused by dogs, cats, and mice by other communities [33]. The plant species Achyranthes aspera is used for easy delivery, to cure fever, to stop bleeding from the gum and to cure boils in early stage by the Juangs which is also used in the treatment of dropsy, rheumatism, stomach problems, cholera, skin diseases and rabies [34,35]. Acorus calamus is another important plant species that has been utilized for the treatment of dysentery, to cure asthma and to increase appetite as well in traditional health care practices among the Juang people. In Ayurveda it is highly valued as a rejuvenator for the brain and nervous system and as a remedy for digestive disorders [36].  [37]. The plant species Smilax zeylanica is used for the treatment of rheumatic pain, venereal diseases and to cure chronic ulcers in the health care practices among the Juang people. In the Indian traditional system of medicine, Streblus asper is prescribed for the treatment of diabetes mellitus. Others studies reported this plant is used as an antidiabetic [38], antihepatitis-B [39,40], antiseptic and astringent [41,42]. The Juang tribes used the Pueraria tuberosa medicinal herb to increase lactation post-delivery, finds mention in the Indian system of Ayurvedic medicine for the treatment of sexual weakness, contraceptive agent, diuretic and galactagogue, and referred as "Vidari" [43]. It is interesting to note that the plant species Wrightia tinctoria and Martynia annua are used for the treatment of morbidity conditions such as paralysis and spondylosis that could not be found in the literature perused for the Odisha region.

Conclusion
It was reported in the study that the knowledge of ethnomedicinal plant has been orally transferred from one generation to another generation and people are reluctant to disclose their knowledge to the outsiders. This is a kind of knowledge that they believe to have acquired from the blessings of their ancestors through which they are getting highly esteemed rank in the society. A traditional healer said that, compared to him his ancestors knew much better and, in the years, passed by this practice has been diminished. Therefore, in the years ahead this practice may be vanished if not property taken care. Due to rapid industrialization, migration to cities and strong affinity towards technology and different social media among the youths, the youths are exposed to new culture while posing new threat to traditional health system.
The traditional health care practice is very much associated with belief, rationality, faith, knowledge and practice as per prescribed norms and values to maintain good health and wellbeing of the

Consent for publication
Not applicable.

Availability of data and materials
The dataset supporting the results and conclusions of this article is included within the article (and its table).

Figure 1
Map showing study area  Statistics of plant parts used Number of Plants used for treatment of various diseases