Indigenous Knowledge and Application of Ethnomedicinal Plants in Western Himalayas


 Background: In the modern era, the practice of herbal medicine for health care practices has been declining and may led to the loss of valuable information about plants used in traditional medicine from ancient times. The present study was aimed to document ethnomedicinal knowledge of plants used by the inhabitants of Garhwal Himalaya for health care management in rural areas and can be base line for the contribution of drug discoveries for Pharmaceutical industries.Methods: A snowball sampling technique was employed to gather information using questionnaires and informal interviews followed by discussions with peer and prominent healer practitioners. Consensus factor (Fic) was used to test the homogeneity in ethnomedicinal knowledge of rural inhabitants. Fidelity level (FL), cultural importance index (CI) were computed for the people depends on plants. Results: A total of 88 medicinal plants species belonging to 45 families with 80 genera were reported for different ailments. The most frequent plant parts usage was from leaves followed by fruits, seeds, roots, bark, and flowers/buds. Skin problems were healed with the highest number of taxa (15 species) with Fic value 0.85. Maximum number of plant species (15 species.) was used for skin treatment followed by wound, cough and digestive problems.Conclusion: A significant relation of medicinal plants usage with distance (access time), and family income was observed. In the recommendation, it might have possibilities for the plants with higher FL and CI can contribute in discovery of new drugs after further pharmacological experiments.


Background
Worldwide humans have explored various approaches of using plant parts to enhance physical and spiritual well-being [1], medicinal plants have continued to gain prominence even in modern era [2].
Throughout the world about 40,000-50,000 plants species are used in traditional and modern medicine systems [3]. According to the World Health Organization (WHO) 65-80% of the world's population particularly in developing countries depends on plants for healing various diseases, as they have accepted it traditional culture [4], poverty and lack of access to modern medicine [5]. Traditionally used medicinal plants have a long history as they are considered safe, non-toxic to the human beings and this concept and knowledge is considered as a major contributory factor for drug discovery by pharmaceutical industries [6].
Most people residing in rural areas depend on subsistence agriculture for their survival and have a great cultural knowledge of curing several diseases by the utilization of various forest resources from ancient times [7,8]. The natural resources particularly forest resources used by diverse ethnic communities for different purposes play a signi cant role in the subsistence economy of the inhabitants [9] through income generation and affordable tool in healthcare [10]. Wild collection practices secure valuable income for many rural household sand provide incentives for conservation and sustainable use of forest vegetation which can play an important role in sustaining local economy [11]. Inhabitants of the hilly tracts particularly in rural areas, have major dependency on forests for subsistence where, a great deal of knowledge on the use of ora has been acquired through generations [12].
The ethnobotanical knowledge arises from a complex interaction between human beings and their surrounding environment [13] which depends on various factors such as local classi cation systems [14] communicated through language [15], human cognition and cultural history [16], beliefs and religion [17], social networks and access to information [18]. Ethnomedicinal research is the study among the rural inhabitants for recording their unique knowledge about plant wealth and search of new resources for preparation of herbal medicines, edible plants for consumption and other aspects of plants [19]. In India, 20% of plant species are used because of their medicinal values [20]. Uttarakhand a Himalayan state, well known for its biotic wealth and variety of cultural heritage covers about 12.18% of the total Indian Himalaya with greater than 40% of diverse forest types comprising the highest cover of natural forest and alpine pastures [21]. The diverse ethnic communities i.e., Garhwali, Jaunsari, Bhotia, Tharu etc., living in the state are dependent on forests for primary health care and for their livelihoods [7].
Herbal practice still plays a signi cant role in managing and curing various health problems particularly in the remote and rural areas of India [22]. The knowledge of medicinal plant conservation and its use has developed a link between promoting environmental conservation and indigenous knowledge [23]. In the present scenario, the practice of herbal medicine has been declining even in the places where it has been once developed and nurtured by oral tradition from generations. This situation may lead to the loss of traditional and valuable information about the plants used in healthcare management in the coming time [24]. The present study was initiated with the objective that; the traditional knowledge of medicinal plants and their uses in healthcare management for rural inhabitants staying in far ung areas of Garhwal Himalaya.

Study area
The present study was conducted in Pauri Garhwal and Rudraprayag Districts of state Uttarakhand ( Fig. 1). The districts extend from 29˚30'-30˚50'N latitude and 78˚10'-79˚20'E longitude. The altitudinal range of all the surveyed villages was between 700 m to 1800 m. The rainfall pattern in the region is largely governed by the monsoon rains during the month of July to September, which accounts for about 60-80% of the total annual rainfall [25]. The region has very a rich biodiversity supporting different forest types, varies in species composition with elevation and latitude and the dominant tree species of the region is Pinus roxburghii (Chir pine).
Agriculture is the primary profession of about 80% of people in western and central Himalaya [26] and about70% of them having land holding size less than 1 ha [27]. Inhabitants of the study area are dependent mainly on forests for diverse needs which are critical for the existence of their livelihoods and wellbeing. Livelihoods of the people are directly or indirectly derived from natural resources, traditional terrace based rainfed agriculture and animal husbandry practices as revealed by rural inhabitants. The agricultural terraces lined with numerous trees, wild bushes, grasses and herbs offer inhabitants fodder for livestock [28]. According to the 2011 census, population of both districts is 9, 29,546 with average literacy rate 82.33% (Table 1) [29].

Sampling techniques
Snowball sampling technique was used for selection of individuals (informants) that had a sound traditional knowledge of medicinal plants used in the area. In the beginning we approached Gram Pradhan (the head of village) and older people of the village, who are with sound knowledge of medicinal plants used in treatment of various health ailments. Once a traditional healer/plant collector was identi ed, snowball sampling was followed to locate and identify the second respondent and so on [30].
Since young generation had less awareness about the traditional knowledge therefore respondents with age group of 50-80 years were taken as sample for data recording. A large number of respondents (75.3%) were literate and were very friendly in disclosing the information about of traditional medicines which was passed on to them from their ancestors.

Field work
A test questionnaire was framed and was used to test the suitability and ow of questions with 48 households in twin districts of Pauri and Rudraprayag with 21 and 27 households respectively. After the changes were incorporated and the questionnaire was reframed again, the information was then gathered through semi-structured questionnaires from 161 households in which 64 were fall in Pauri and 97 from Rudraprayag. The semi-structured interviews were conducted, in Hindi or local dialect (Garhwali) for documentation of plants species which are used for traditional medicines.
Before starting of an interview, the inhabitants were advised about the purpose of the study and interview.
Most of the information about the medicinal plants was recorded from the older people of the villages and mainly for plants medicinally important, plant parts used, name of the disease for which a particular plant they are using, etc. The published literature and consensus of the inhabitants was also used for the plants which were recorded in the study area. The collected plant specimens were identi ed and con rmed from the traditional healers and the people who are using these plants in their daily routine for medicinal purposes. Flora of Garhwal Himalayas was also used to cross check the species local name and scienti c nomenclature [31; 32]. The specimens were then processed in the Laboratory, veri ed by curator and submitted to Garhwal University Herbarium.

Informant consensus factor
Data collected during eldwork was entered in a database i.e., information was structured in use-reports (UR), where the informant i, mentions the use of the species s in the use-category u [33]. A consensus survey was conducted based on people's agreement on the number of plants used for a particular health ailment. To test homogeneity of traditional medicinal knowledge about the plants, the informant consensus factor (F ic ) was used [34]. The F ic for each of the recorded plant species was calculated using the following formula: Where, N ur is the number of use reports for particular health problem and N t is the number of species used for a particular health problem by all the informants.

Fidelity value ( )
The delity level [35] is the percentage of informants claiming the use of a certain plant species for the same major purpose, was calculated as: Where, I p is the number of informants indicating independent use of a species for the same major ailment and I u is the total number of informants mentioning the use of plant for any major ailment.
To assess the importance of each species, cultural importance index (CI) was calculated by dividing the number of UR in use-category by the number of informants [33] using the following formula: Where UR is the number of use reports in various health problems (NC) and N is the total number of informants.
One-way ANOVA and binary logistic regression analysis was used to estimate the relationship between various household factors and use of medicinal plants. Description of various explanatory variables has been provided in Table 2a.

Results
The existing traditions of managing different diseases by inhabitants of Pauri and Rudraprayag district have been recorded and which is presented in the Table 3. A total of 88 medicinal plants were recorded under 46 families and 80 genera. The plant parts used included leaves, roots and underground parts. In the present study maximum number of plant species (15 species) were used for skin treatment followed by wound, cough (10 species each); digestive problem (9 species); diabetes (8 species); respiratory problems (7 species); stomach problem (6 species); blood pressure, cattle diseases, dysentery, fever, ulcer (5 species each); cut wounds, diarrhea, eye problems (4 species each); piles, hair treatment, skin burn (3 species each); rheumatic pain, cholesterol problems, liver problems, appetite improvement, ear ache, cold, bone problem, astringent, anemia, urinary issues (2 species each); antioxidant, back ache, cancer and tuberculosis, throat infections, dengue, heel crack, insecticide and nematicide, kidney stones, paralysis, pyorrhea, scorpion bites and snake bites, tooth ache (1 species each) (Fig. 2). Among the different plant parts used leaves contributed the most (30.7%) followed by fruits (27.3%), seeds (17%), roots (12.5%), bark (10.2%), owers (8%), whole plants (6.8%); tuber/rhizome/bulb, twig, latex (4.5% each); gum and stem (2.3% each) and resin, pollen dust (1.1% each) (Fig. 3). The practice of using medicinal plant resources in health care management by rural households' is a part of their cultural tradition, which is passed to them from generations. This observations during study reveals that local people are dependent on a number of plants for their daily needs especially medicines and nutrition.

Consensus of medicinal plants
Medicinal plants used for different ailments and these ailments were classi ed into 40 groups and F ic values for each category are mentioned in Table 4. The results of the F ic showed that the antioxidant; back ache; cancer and tuberculosis; throat infections; dengue, healing heal crack; insecticide and nematicide; kidney stones; paralysis; pyorrhea; scorpion and snake bites; and tooth ache category had the greatest agreement with a F ic of (1.00), followed by cold, appetite improvements and cholesterol level reduction (0.98); hair treatments (0.97); urinary infections and bone problems (0.96); ear ache and eye problems (0.95); astringent and cuts (0.94). The least agreement between the informants was recorded in the piles and ulcer with F ic value of (0.50). Skin problems were cured with the highest number of taxa (15 spp.) with F ic value 0.85 ( Table 4). The awareness about the species used in skin related problems was observed high in the study area.
The inhabitants of the study area are engaged in various activities and have to face many issues while collecting fuelwood and fodder; cooking food in traditional stoves; agricultural farming in hilly terrains; carrying of portable water from distant places. These situations lead inhabitants to suffer from many skin related problems, such as ringworm, skin disorders, skin allergy, fungal infection, skin dryness, skin infection etc.

Cultural importance of medicinal plants
The study results revealed that Trigonella foenumgraecum and Allium sativum with CI value 0.292 were the most used species in health care mangement with 47 use reports each. The results further reported that the most important species used in treating skin related problems were Artemesia wallichiana and Phyllanthus emblica with CI value 0.273 and 0.205 respectively indicating more use of these species by the inhabitants due to availability of plant species and knowhow of their use in treating skin problems.
The ANOVA analysis shows that distance of household from hospital (F = 3.600; p < 0.05), monthly income of family (F = 8.614; p < 0.05) are the main in uencing factors favoring the use of medicinal plants for curing health problems followed by distance of household from forest (F = 4.766; p < 0.05) (Table 2b).

Discussion
The results revealed that local traditional knowledge play an essential role in primary healthcare and the practice of plant-based medicine are still prevalent in rural areas of Garhwal region. The traditional herbal medicine is considered as the lifeline, the rst choice, with fewer side effects, better patience tolerance, relatively economic, cultural recognition and long history of use, in comparison to pharmaceutical medicine [36]. Local people show preferences to the use of traditional herbal remedies due to their belief in the effectiveness of folklore herbal remedies [22]. In this study it was found that use of ethnomedicinal plants in herbal care at higher elevation was found to be higher due to lack of alternative options and accessibility to markets. The recognition and escalating faith in herbal medicine of medicinal plants has persistent in remote areas due to low price and fewer side effects as compared to general medicines [37].
In an ethnomedicinal study of Kedarnath Wildlife Sanctuary Malik et al. [22] reported that the most contribution of plant parts used was roots (33%), followed by leaves (27%), bark (20%), etc., which was partially inconsistent to our ndings as the inhabitants were less aware about the medicinal use of root parts. Sharma et al [25] also reported uses of different plant parts and the most commonly used plant part in preparation of herbal ointment was leaves followed by seeds, roots, whole plant, stem, ower and fruit. Ayyanar and Ignacimuthu [38] suggested that the most of the studies con rmed the medicinal uses of leaves in treatment of various health illnesses.
Consensus factor analysis was performed to measure the reliability of the informant's claim about the plant use [39]. High F ic value indicates the use of some plants by many inhabitants in curing a particular health illness whereas; low value means use of different plants by many inhabitants in curing a particular health illness [40]. Cultural importance of a plant depends on the versatility of plants with different uses than to those with only one use [33]. Many studies have also claimed the use of Artemesia spp. in treating various skin diseases [8,41].
Medicinal plants and their traditional formulations have always been a part of social life of rural communities, which have proved to be very helpful in tackling various health related issues [42]. The dependency of the villagers on medicinal plants increased due to lack in healthcare facilities. The informants of the study area informed that medicinal plants serve as an important source in healthcare and the associated knowledge, which was traditionally transmitted and thus improving health conditions of human beings [43]. After having discussion with respondents in the study area, it was observed that older people believe more on the ethnomedicinal plants for curing different health issues.
Pharmaceutical medicines cure a range of diseases; however, their higher prices and side effects limit their applications therefore people living in remote areas who are associated with nature and medicinal plants from generations have involved themselves in using herbal medicines as they have fewer sideeffects [38]. Due to globalization and its in uence on cultural settings, has led to depletion of traditional knowledge in several areas including the Himalaya, due to unorganized way of knowledge transfer to the new generations [44].
This state of affairs can lead to eradication of vast ethnomedicinal understanding of the region if proper documentation is not taken care of. Therefore, to preserve traditional medicinal knowledge, the importance of herbal practitioners and their role in primary health care systems should be recognized at the regional as well as national level. This can be achieved by capacity building of herbal practitioners and education of new generations which will have substantial impact on the long-standing sustainability of herbal knowledge [45]. Furthermore, there is an urgent need to document this information, as it is rapidly declining due to in uence of pharmaceutical medicines [46]. Thus, it is important to collect this information and develop a data base of medicinal plants for future research and potential development of new herbal medicines.
The wider application and adaptation of uses of ethno-medicinal plants, and the inclusion of traditional knowledge in decision making processes at highest level is of great importance. Most of the documented species in the present study have also been reported for multiple uses in various regions of the globe (Table 5). Multiple uses of these plants may incite the appropriate authorities to frame better conservation and management strategies for the plants used in medicinal purposes.

Conclusion
This This study provides base line information for more scienti c studies that may lead to the discovery of new plant-based drugs which will help in the development of effective herbal medicines in coming decades. In present scenario more dependency of young peoples on allopathic medicine system has led Page 36/45 to degradation of traditional knowledge system. Therefore, it is the necessity in the present circumstances to document the traditional knowledge related to medicinal uses of plants and its conservation for future generations. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Number of plant species (taxa) used in different health issuess.