Ethnobotanical Survey of Medicinal Herbs in the Western Region in Syria (Latakia and Tartus)


 ContextThe use of traditional Arabic medicine (TAM) has spread to treat various diseases in Syria since ancient time. They are cost-effective with fewer side effects and are more suitable for long-term use compared with chemically synthesized medicines.ObjectiveWe conducted ethnobotanical and ethno-medicine research on plants traditionally used to treat various diseases in Western region of Syria. MethodsField surveys were conducted during July 2019-December 2020 to document ethnobotanical information through oral interviews and designed semi-structured questionnaire from local herbalists (Tabib Arabi) and the elderly people and others who were familiar with traditional uses of plants particularly for medicinal. The queries were repeatedly made to increase the reliability of the data, during the field survey of 475 local inhabitants of 70 villages. ResultsIn this research we listed 258 medicinal plants belonging to 83 families in alphabetical order with the parts used and the method of preparation according to their therapeutic use. Of these studied plants, 185 are used to treat digestive disorders, 118 for respiratory diseases, 91 for several skin diseases, 87 for kidney and urinary tract disorders, 78 for diabetes, 18 for nervous system disorders, and a few plants for treatment the other diseases which are commonly spread in study area. The calculated results of medicinal use-value (MUV) showed that Olea europaea L., Origanum syriacum L. was ranked first (MUV= 0.934), while the lowest value was found for Fumana thymifolia (L.) Spach and Cistus creticus L. (MUV= 0.003).ConclusionA large portion of the uses of medicinal plants mentioned in the research are still under study. There is no doubt that its study will provide many new data that could contribute to further pharmacological discoveries by identifying the active ingredients and their mechanism of effect by doing a lot of pharmacological work to confirm the alleged biological activities of these plants.


Introduction
Traditional medicine (TM), as de ned by the World Health Organization (WHO), is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement, or treatment of physical and mental illness. Some traditional medicine systems are supported by huge volumes of literature and records of the theoretical concepts and practical skills; others pass down The information gathered during the present study included socio-demographic characteristics of the interviewed informants (age, gender) and ethnopharmacological information, including the local and scienti c name of the species, local names, plant parts used, modes of use, conservation method, administration mode and toxicity, all documented data were then translated into English and Latin.

Taxonomic identi cation of the species
Medicinal plants being mentioned by the Informants were recorded with local names and photographed. Each reported medicinal plant species was gathered, compressed, dehydrated, mounted on herbarium sheets, and identi ed, the taxonomic identity of the plants was con rmed by Prof. Abdel Aleem Bello (PhD / Botanical Taxonomy) and Dr. Bayan Tiba (PhD / Botanical Taxonomy) Aleppo university, As far as possible, the name of the plants was updated by consulting the latest literature; generic and species names followed the plant list (http://www.theplantlist.org). All voucher specimens have been preserved during documentation and deposited in the Damascus University, faculty of pharmacy, pharmacognosy labs Herbarium for future reference.

Ethics approval and consent to participate
The study was approved by the Ethics Committee of the University of Damascus. Before beginning data collection, we obtained verbal informed permission in each case site-wide and then individually before each interview. We also informed informants that it was an academic project and that the investigation was for research purposes only, and not for any nancial or other bene ts. Informants provided verbal informed consent to participate in this study; They were free to withdraw their information at any time. These informants freely accepted the interview.

Consent for publication
The study has a consent for publication by the faculty of pharmacy -University of Damascus on 7/3/2021 .

Data analysis
The data collected through interviews of the informants were classi ed and examined with the statistical program IBM® SPSS® Statistics 26, to determine the proportions of different variables such as ethnopharmacological data. Quantitative value indices were analyzed using different statistical quantitative tools i.e. the use reports (UR) of a species, and medicinal use value (MUV) (Chaachouaya et al. 2021).

Medicinal use-value (MUV) and use reports (UR)
The use reports (UR) of a species or its importance in the culture of a community is denoted by its mentioning rate or its mention frequency by informants. The UR of the species of plants being utilized was evaluated using the formula (Tenté et al 2012): Ni: the number of times a particular species was mentioned Page 6/75 n: the total number of times that all species were mentioned The MUV of recorded medicinal plants was determined by applying the following formula (Tabuti et al. 2003): MUV= ∑ URi/N ∑ URi: the total number of use reports per plants N: the total of interviewees questioned for given medicinal species The MUV rate will be more important if there are several useful records for a species, implying that the plant is signi cant, whereas they will be near 0 if there are few reports compared to its use (Chaachouaya et al. 2021, Yaseen et al. 2015).

Demographic data of informants
In total, 475 local inhabitants of 70 villages were selected based on their experience in traditional uses of plants particularly for medicinal, (Table 1) show the age and gender wise distribution. All of them were interrogated using semi-structured questionnaires. Generally in Syria, both genders were interested in herbal medicines. While in the countryside (the study area), women are more interested in livelihood, treatment, plant collection and processing compared to men, so that the percentage of informants was 54.94% females, 45.05%, males, and most of them were older than 50 years.

Ethnobotanical uses of plant species
A total of 258 plant species belonging to 83 families are recorded in the present study, which are being used for a variety of purposes by native people. The detailed inventory is provided in Table 2, which includes botanical names, followed by local name, family and ethnobotanical uses. (Gar) Lauraceae L, F 0.923 The industry of Aleppo laurel soap in Syria from laurel oil in the Syrian coast, especially the Kassab region with olive oil, and this industry has developed so that it produces one of the best types of soap in the world. An infusion of leaves is used to treat common cold, u, and bronchitis, to facilitate digestion, appetite, stomach and intestinal infections, diabetics, relief from fatigue and psychological frustration, and used as body refreshment, and for migraine and headache relief. Gargle with laurel leaves water, which helps to clean the mouth, throat and nose, and to calm tooth ache. Laurel fruits oil is used externally to relieve rheumatism, joint and muscle pain, treat mycosis, skin diseases, psoriasis, and treat boils and premolars. Aromatic laurel leaves water is used for cosmetic purposes, to cleanse the face, and to relieve acne and pimples. No.

Name of Species
Alliaceae L 0.014 A decoction of leaves and fruit peels are astringent, and for menstruation, hepatitis, colon disorders, venous insu ciency, hemorrhoids, asthma, uterine infections, and a diuretic for cases of urinary system infections, and is also used in the treatment of jaundice, and urinary tract stones, also it is used to heal broken bones, and twisted joints.
No. decoction (21.35%), then other method such as juice, roasted, cooked, boiled, powder, and soak in oils (38.53%). Considered according to results that most of the plant preparations are used orally. (Table 2).

Ethno medicinal information about treatment the different diseases:
The results of questionnaires showed that 15% of the informants were diagnosed with their diseases by a doctor, and 38% were diagnosed with a conventional therapist, and 47% self-diagnosed their diseases, while the results of the questionnaires showed that the evaluation of the treatment by informants as following (64% relied on the disappearance of symptoms, and 22% Through the results of laboratory analysis, 14% adopted other methods such as chest radiography, adopting the attending physician's opinion and clinical observation of the improvement of skin diseases, and some of them depended on psychological comfort during treatment as evidence of improvement).
Of these studied plants, 185 are used to treat digestive disorders, 118 for respiratory diseases, including asthma, bronchitis and coughs, 91 for several skin diseases, 87 for kidney and urinary tract disorders, 78 for diabetes, 18 for nervous system disorders, and a few plants for treatment the other diseases such as enhance the body's immunity, hemorrhoids, fever, heart disorders, infertility and impotence, treating several types of cancer, increasing breast milk production, losing weight, lowering cholesterol, increasing weight, anemia, blood disorder, anti-toxicant, arthritis and pain, typhoid disorder, infections, gynecological diseases, eye in ammation, anti-toxicant, mouth sores ( Figure 4); Many of them are still used today, especially those plants recommended for internal uses such as traditional medicinal teas, which mainly consist of remedies for obesity, weight loss, colds, colds, digestive disorders, abdominal pain, constipation and some skin diseases, and there are many factories that produce medicinal tisane.

Discussion
The use of traditional Arabic medicine (TAM) has spread to treat various diseases in Syria since ancient time.
They are cost-effective with fewer side effects and are more suitable for long-term use compared with chemically synthesized medicines.
In this research a questionnaire was administered to the 475 informants (local inhabitants) of 70 villages through face-to-face interviews, we listed 258 medicinal plants belonging to 83 families in alphabetical order with the parts used and the method of preparation according to their therapeutic use. Of these studied plants, 185 are used to treat digestive disorders, 118 for respiratory diseases, 91 for several skin diseases, 87 for kidney and urinary tract disorders, 78 for diabetes, 18 for nervous system disorders, and a few plants for treatment the other diseases which are commonly spread in study area. The calculated results of medicinal use-value (MUV) showed that Olea europaea L., Origanum syriacum L. was ranked rst (MUV= 0.934), while the lowest value was found for Fumana thymifolia (L.) Spach and Cistus creticus L. (MUV= 0.003).
Ethnobotanical use categories indicated that there is large use of medicinal herbs in the area of study, most of them are wild. Increased exploitation of medicinal plants by the local population, collectors and dealers of herbal medicines, in line with the demand from the pharmaceutical industry. This caused a sharp decrease in the occurrence and products of medicinal plants. Grazing, deforestation by cutting down trees for heating, and res were mainly responsible for the reduction of medicinal plants. so that the government is working on developing strategies to conserve wild plant diversity. Some people collect the medicinal plants for an income.
They uproot and collect each part of the medicinal plants in non-scienti c way. Thus, to date, a few articles devoted to traditional medicine of Syria have been published for one on the folk medicine in Aleppo governorate (Alachkara et al. 2011), and another for the use of "Zahraa" (Syrian traditional tisane) (Carmona et al. 2005), and third one on the medicinal plants in Golan (Said et al. 2002), which is an occupied Syrian territory.
It is hoped that this research will contribute a lot in providing a useful information on the conservation and sustainable use of the natural resources of the area.
The information contained in the questionnaire was compared with ethnomedicine studies in the countries surrounding Syria such as Lebanon (Taha et al. 2013), Jordan (Lev & Amar 2002; Al-Qura'n 2009), Palestine (Friedman et al. 1986;Kaileh et al. 2007), Iraq (Al-Douri 2000) and Turkey (Yesilada et al. 1995;Sezik et al. 2001). We noticed a similarity in a lot of traditional uses in Syria, Lebanon, Palestine, and Jordan, the reason for this is due to mutual history of these areas were previously called Bilad Al-Sham; and there is some similarity with a smaller number of folk uses between Syria and Iraq, and there is a difference in the folk uses described between Syria and Turkey.
We did not record signi cant differences in phytomedicines consumption customs between interviewees of different religions In general, phytomedicines consumption was often explained and justi ed by interviewees as family tradition. We did not detect any gender-related differences in phytomedicines consumption. However, there weren't gender differences concerning the common traditional use of medicinal plants. The ethno-medicine data presented here in imply that medicinal plants are important as food and particularly as medicine (traditional healing) for various local people. While chemical medicinal treatments are becoming commonplace, traditional medications are still of huge importance in many rural, poor and remote places.
There is no doubt that its study will provide many new data that could contribute to further pharmacological discoveries by identifying the active ingredients and their mechanism of effect by doing a lot of pharmacological work to con rm the alleged biological activities of these plants, and the possibility of developing new pharmaceutical formulas cannot be excluded depending on Syrian medicinal plants and their folk uses. as the discovery of artemisinin from Artemisia annua, based on ethnobotanical information (Acton & Klayman 1985), serves as evidence that it is possible to nd new and effective medicines using data from traditional medicine.

Limitations
There is insu cient information about the pharmacokinetic e cacy of the medicinal plant species in this study. These herbs that have been reported that have been used traditionally as adjuvant to relieve and treat some diseases.

Conclusion
A large portion of the uses of medicinal plants mentioned in Syria are still under study. There is no doubt that its study will provide many new data that could contribute to further pharmacological discoveries by identifying the active ingredients and their mechanism of effect by doing a lot of pharmacological work to con rm the alleged biological activities of these plants.

Declarations
Financial support (Funding) This study did not receive any particular gift from funding companies in the public, commercial, or not-forpro t sectors.

Declaration of Competing interests
We declare that there is no con ict of interest with any business organization concerning the study.  Geographical Location of the study area, Latakia & Tartus (Yaseen 2010). Note: The designations employed and the presentation of the material on this map do not imply the expression of any opinion whatsoever on the part of Research Square concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. This map has been provided by the authors.  Parts used for ethnomedicinal purpose of ora related to Western region in Syria (Latakia and Tartus).